Healthcare Provider Details

I. General information

NPI: 1841838869
Provider Name (Legal Business Name): LESLEY STYERS PLOWMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL PARK DR
CONWAY SC
29526-9260
US

IV. Provider business mailing address

100 PROFESSIONAL PARK DR
CONWAY SC
29526-9260
US

V. Phone/Fax

Practice location:
  • Phone: 843-234-0005
  • Fax:
Mailing address:
  • Phone: 843-234-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number23619
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23619
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: