Healthcare Provider Details

I. General information

NPI: 1215260435
Provider Name (Legal Business Name): VERNICA ROBERSON MS, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 E. COLUMBIA AVE. STE.B
BATESBURG-LEESVILLE SC
29070-9285
US

IV. Provider business mailing address

PO BOX 3788
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 803-532-1580
  • Fax: 803-532-3832
Mailing address:
  • Phone: 803-733-5969
  • Fax: 803-753-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA3330
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN129143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: