Healthcare Provider Details

I. General information

NPI: 1124675194
Provider Name (Legal Business Name): ERIN E. EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN E REID

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTHY WAY STE 1200
ANDERSON SC
29621-7916
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-6140
  • Fax: 864-512-6149
Mailing address:
  • Phone: 864-512-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23183
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: