Healthcare Provider Details

I. General information

NPI: 1205627437
Provider Name (Legal Business Name): BRITT MARIE BROADWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 SALUDA POINTE DR
LEXINGTON SC
29072-7295
US

IV. Provider business mailing address

7613 GARNERS FERRY RD
COLUMBIA SC
29209-3811
US

V. Phone/Fax

Practice location:
  • Phone: 803-785-3590
  • Fax: 803-785-3595
Mailing address:
  • Phone: 803-427-7199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30365
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: