Healthcare Provider Details

I. General information

NPI: 1760091482
Provider Name (Legal Business Name): MELINDA GALFORD HEFFERNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 WOODRUFF RD
SIMPSONVILLE SC
29681-5447
US

IV. Provider business mailing address

2580 WOODRUFF RD
SIMPSONVILLE SC
29681-5447
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23949
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: