Healthcare Provider Details

I. General information

NPI: 1841601481
Provider Name (Legal Business Name): ASHLEY M KIRINCICH-SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

PO BOX 935722
ATLANTA GA
31193-5722
US

V. Phone/Fax

Practice location:
  • Phone: 803-409-7170
  • Fax: 803-409-7175
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24405
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number210693
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number24405
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number24405
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number24405
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: