Healthcare Provider Details

I. General information

NPI: 1710333133
Provider Name (Legal Business Name): ANDREA WEBB OATES MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RICHLAND MEDICAL PARK, SUITE 420
COLUMBIA SC
29203-8004
US

IV. Provider business mailing address

3555 HARDEN STREET EXT 15 MEDICAL PARK, SUITE 300
COLUMBIA SC
29203-6894
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-6050
  • Fax: 803-545-6051
Mailing address:
  • Phone: 803-545-5017
  • Fax: 803-255-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209995
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20247
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: