Healthcare Provider Details

I. General information

NPI: 1508324302
Provider Name (Legal Business Name): ERICA SIMMONS YANG WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 08/22/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W HILL BLVD
CHARLESTON SC
29404-4704
US

IV. Provider business mailing address

204 W HILL BLVD
JOINT BASE CHARLESTON SC
29404-4704
US

V. Phone/Fax

Practice location:
  • Phone: 843-963-6541
  • Fax: 843-963-6730
Mailing address:
  • Phone: 843-963-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number900668
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number24489
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: