Healthcare Provider Details

I. General information

NPI: 1326963224
Provider Name (Legal Business Name): MATTIE FUERST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SC-90
CONWAY SC
29526
US

IV. Provider business mailing address

204 BRECKENRIDGE
OKLAHOMA CITY OK
73114-7717
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-3377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number32414
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: