Healthcare Provider Details

I. General information

NPI: 1255268389
Provider Name (Legal Business Name): NICOLA SOPHIA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICO BROWN

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S BROAD ST
CLINTON SC
29325-2865
US

IV. Provider business mailing address

503 S BROAD ST
CLINTON SC
29325-2865
US

V. Phone/Fax

Practice location:
  • Phone: 864-938-3745
  • Fax:
Mailing address:
  • Phone: 864-938-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: