Healthcare Provider Details

I. General information

NPI: 1548066707
Provider Name (Legal Business Name): DAMINI T PATEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HIGHWAY 90
CONWAY SC
29526-9630
US

IV. Provider business mailing address

300 SINGLETON RDIGE RD ATTN PNS CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-3377
  • Fax: 843-399-3378
Mailing address:
  • Phone: 843-234-6996
  • Fax: 843-234-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30689
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: