Healthcare Provider Details

I. General information

NPI: 1669646790
Provider Name (Legal Business Name): PATRICIA AJOA YEBOAH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MEETING ST
LANCASTER SC
29720-2202
US

IV. Provider business mailing address

PO BOX 935722
ATLANTA GA
31193-5722
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25126
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335365-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: