=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548066707
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAMINI T PATEL FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2025
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 HIGHWAY 90
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29526-9630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-399-3377
-----------------------------------------------------
Fax | 843-399-3378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 SINGLETON RDIGE RD ATTN PNS CREDENTIALING
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29526-9142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-234-6996
-----------------------------------------------------
Fax | 843-234-8958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 30689
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------