Healthcare Provider Details

I. General information

NPI: 1780452144
Provider Name (Legal Business Name): ABBY WHITE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 HAILE ST
CAMDEN SC
29020-3076
US

IV. Provider business mailing address

313 BELFAIR RD
IRMO SC
29063-8292
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-1931
  • Fax:
Mailing address:
  • Phone: 803-955-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28164
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: