Healthcare Provider Details

I. General information

NPI: 1699513838
Provider Name (Legal Business Name): NIKKI SAWYER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 GATEWAY CORPORATE BLVD
COLUMBIA SC
29203-9685
US

IV. Provider business mailing address

114 GATEWAY CORPORATE BLVD STE 110
COLUMBIA SC
29203-9785
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-4514
  • Fax:
Mailing address:
  • Phone: 803-865-4960
  • Fax: 803-865-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29155
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: