Healthcare Provider Details

I. General information

NPI: 1780465732
Provider Name (Legal Business Name): MEGAN BARKER BOTTS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 CRESTVIEW RD
EASLEY SC
29642-2408
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-5006
  • Fax: 864-850-1992
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27977
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: