MEDICARE: REBECCA SMITH

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	29198	SC

General Provider Information

NPI Number	:	1841018363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA SMITH

Provider Business Mailing Address
First Line	:	1936 BERKLEY VILLAGE LOOP
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3715
Country	:	US
Telephone Number	:	540-493-1329
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 US-378
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29527
Country	:	US
Telephone Number	:	843-606-0001
Fax Number	:

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

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	05/29/2026

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Directions to “ REBECCA SMITH ” Practice Location

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