Healthcare Provider Details

I. General information

NPI: 1326504127
Provider Name (Legal Business Name): STEPHANIE MITCHELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 PAMPLICO HWY STE 300
FLORENCE SC
29505-6047
US

IV. Provider business mailing address

805 PAMPLICO HWY STE 300
FLORENCE SC
29505-6047
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-7529
  • Fax: 843-673-7532
Mailing address:
  • Phone: 843-673-7529
  • Fax: 843-673-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22585
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: