Healthcare Provider Details

I. General information

NPI: 1154297273
Provider Name (Legal Business Name): NYKEIA SMALLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3728 LOWCOUNTRY HWY
YEMASSEE SC
29945-4112
US

IV. Provider business mailing address

3728 LOWCOUNTRY HWY
YEMASSEE SC
29945-4112
US

V. Phone/Fax

Practice location:
  • Phone: 843-599-3523
  • Fax: 843-844-8691
Mailing address:
  • Phone: 843-599-3523
  • Fax: 843-844-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number616CNW
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: