Healthcare Provider Details

I. General information

NPI: 1053502831
Provider Name (Legal Business Name): CAROL JEAN ANDERSON MSN, FNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 HUMAN SERVICES RD
CLINTON SC
29325-7546
US

IV. Provider business mailing address

93 HUMAN SERVICES RD
CLINTON SC
29325-7546
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-0000
  • Fax: 864-833-6400
Mailing address:
  • Phone: 864-833-0000
  • Fax: 864-833-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF2021
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: