Healthcare Provider Details

I. General information

NPI: 1316314412
Provider Name (Legal Business Name): SCARLETT MANCHIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PHYSICIANS LN
SUMTER SC
29150-3370
US

IV. Provider business mailing address

3377 US ROUTE 60
HUNTINGTON WV
25705-2837
US

V. Phone/Fax

Practice location:
  • Phone: 803-340-5110
  • Fax: 803-433-5636
Mailing address:
  • Phone: 304-525-3334
  • Fax: 304-525-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25357
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71024
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN71024-FNPBC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: