Healthcare Provider Details

I. General information

NPI: 1710848924
Provider Name (Legal Business Name): PAIGE THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 DELANO WAY
MYRTLE BEACH SC
29588-9700
US

IV. Provider business mailing address

205 DELANO WAY
MYRTLE BEACH SC
29588-9700
US

V. Phone/Fax

Practice location:
  • Phone: 804-380-6171
  • Fax:
Mailing address:
  • Phone: 804-380-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31175
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: