Healthcare Provider Details

I. General information

NPI: 1144142613
Provider Name (Legal Business Name): COURTNEY BRIANA PITTMAN WAGES DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 KNOX ABBOTT DR
CAYCE SC
29033-3326
US

IV. Provider business mailing address

PO BOX 23321
NEW YORK NY
10087-4321
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number32431
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: