Healthcare Provider Details

I. General information

NPI: 1891210928
Provider Name (Legal Business Name): KAREN P SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WACCAMAW MEDICAL PARK DR
CONWAY SC
29526-8903
US

IV. Provider business mailing address

2249 AIMWELL RD
ANDREWS SC
29510-5853
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5060
  • Fax: 843-347-3959
Mailing address:
  • Phone: 843-325-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number225888
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: