Healthcare Provider Details

I. General information

NPI: 1164763595
Provider Name (Legal Business Name): ASHLEY KRISTEN TROUTMAN HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 FOREST DR STE 4
COLUMBIA SC
29206-3125
US

IV. Provider business mailing address

4711 FOREST DR STE 4
COLUMBIA SC
29206-3125
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-6688
  • Fax:
Mailing address:
  • Phone: 803-788-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-0651
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: