Healthcare Provider Details

I. General information

NPI: 1902874860
Provider Name (Legal Business Name): FARRAH SCHILDKNECHT R.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 200 14 MEDICAL PARK SUITE 200
COLUMBIA SC
29203-6882
US

IV. Provider business mailing address

PO BOX 22265
BELFAST ME
04915-4473
US

V. Phone/Fax

Practice location:
  • Phone: 803-227-8000
  • Fax: 803-227-8015
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number075211
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: