Healthcare Provider Details

I. General information

NPI: 1629378054
Provider Name (Legal Business Name): STEPHANIE L MCCRAVY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 SUNSET BLVD STE B
WEST COLUMBIA SC
29169-3420
US

IV. Provider business mailing address

2858 SUNSET BLVD
WEST COLUMBIA SC
29169-3420
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-9073
  • Fax: 803-764-3215
Mailing address:
  • Phone: 803-699-9073
  • Fax: 803-764-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberR95364
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3965
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: