Healthcare Provider Details

I. General information

NPI: 1144828468
Provider Name (Legal Business Name): IVY HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N MAIN ST STE 201
COLUMBIA SC
29203-5800
US

IV. Provider business mailing address

100 OLD CHEROKEE ROAD STE F BOX 365
LEXINGTON SC
29072
US

V. Phone/Fax

Practice location:
  • Phone: 803-260-3679
  • Fax:
Mailing address:
  • Phone: 803-260-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SHEILA DARLENE BELTON-GAYMON
Title or Position: NURSE PRACTITIONER/ CO-OWNER/MEMBER
Credential: DNP, APRN, FNP B-C
Phone: 803-260-3679