MEDICARE: MRS. ALICIA WILLIAMS ANDERSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	17809	SC

General Provider Information

NPI Number	:	1093075269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA WILLIAMS ANDERSON FNP

Provider Business Mailing Address
First Line	:	PO BOX 2128
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-2128
Country	:	US
Telephone Number	:	843-945-3030
Fax Number	:	854-212-7381

Provider Business Practice Location Address
First Line	:	185 FRESH DR STE A
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4436
Country	:	US
Telephone Number	:	843-945-3030
Fax Number	:	843-650-4019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	08/27/2025

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