Healthcare Provider Details

I. General information

NPI: 1093671398
Provider Name (Legal Business Name): WIMBERLY THIGPIN MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST
ANDERSON SC
29621-1580
US

IV. Provider business mailing address

800 N FANT ST
ANDERSON SC
29621-5708
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-4216
  • Fax:
Mailing address:
  • Phone: 864-512-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP312883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: