MEDICARE: MR. PATRICK C. FAHEY III PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	31765	SC

General Provider Information

NPI Number	:	1841125887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK C. FAHEY III PMHNP-BC

Provider Business Mailing Address
First Line	:	328 GLENLEA LN
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1229
Country	:	US
Telephone Number	:	864-884-5274
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 GLENLEA LN
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1229
Country	:	US
Telephone Number	:	864-884-5274
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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