Healthcare Provider Details

I. General information

NPI: 1902710718
Provider Name (Legal Business Name): SADIE LOUISE MENDENHALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 AUGUSTA HWY STE 100
GILBERT SC
29054-8893
US

IV. Provider business mailing address

120 MIDDLEBROOK DR
LEXINGTON SC
29072-3424
US

V. Phone/Fax

Practice location:
  • Phone: 803-893-1800
  • Fax:
Mailing address:
  • Phone: 803-261-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32839
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: