Healthcare Provider Details

I. General information

NPI: 1922910736
Provider Name (Legal Business Name): CARMEN MIDDLETON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 MALL DR
NORTH CHARLESTON SC
29406-6514
US

IV. Provider business mailing address

2470 MALL DR
NORTH CHARLESTON SC
29406-6514
US

V. Phone/Fax

Practice location:
  • Phone: 855-694-8288
  • Fax:
Mailing address:
  • Phone: 855-694-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number58185
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: