Healthcare Provider Details

I. General information

NPI: 1578504924
Provider Name (Legal Business Name): SARAH A. DERRICK F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH A. PARNELL DNP

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CAROLINA OAKS DR
FOUNTAIN INN SC
29644-8505
US

IV. Provider business mailing address

31 CAROLINA OAKS DR
FOUNTAIN INN SC
29644-8505
US

V. Phone/Fax

Practice location:
  • Phone: 864-980-3202
  • Fax:
Mailing address:
  • Phone: 864-980-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1958
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1958
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9388607
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007132
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: