Healthcare Provider Details

I. General information

NPI: 1487519161
Provider Name (Legal Business Name): ANESSIA BETTINA FRIESON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 3RD AVE
CONWAY SC
29526-5038
US

IV. Provider business mailing address

737 N MAIN ST
MULLINS SC
29574-1723
US

V. Phone/Fax

Practice location:
  • Phone: 888-515-3007
  • Fax:
Mailing address:
  • Phone: 843-289-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31343
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: