Healthcare Provider Details

I. General information

NPI: 1003230780
Provider Name (Legal Business Name): RICHARD DALE BRINSON MSN, APRN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
NORTH CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

1802 CANAL DR
MONCKS CORNER SC
29461-9227
US

V. Phone/Fax

Practice location:
  • Phone: 843-847-4595
  • Fax:
Mailing address:
  • Phone: 843-934-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number18671
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number18671
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18671
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: