Healthcare Provider Details

I. General information

NPI: 1265250369
Provider Name (Legal Business Name): LESSIE LENORA MULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

224 LIBERTY RIDGE DR
ELGIN SC
29045-7905
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 803-777-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number30871
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: