Healthcare Provider Details

I. General information

NPI: 1003446998
Provider Name (Legal Business Name): CASSANDRA NICOLE CALLOWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4184 DOBYS BRIDGE RD STE 104
INDIAN LAND SC
29707-6910
US

IV. Provider business mailing address

4184 DOBYS BRIDGE RD STE 104
INDIAN LAND SC
29707-6910
US

V. Phone/Fax

Practice location:
  • Phone: 803-548-2230
  • Fax: 803-548-2288
Mailing address:
  • Phone: 803-548-2230
  • Fax: 803-548-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23521
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: