Basic Information
Provider Information | |||||||||
NPI: | 1063696490 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PADGETT | ||||||||
FirstName: | DONNA | ||||||||
MiddleName: | B. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ACNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BUTLER | ||||||||
OtherFirstName: | DONNA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | NP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2720 SUNSET BLVD | ||||||||
Address2: | ATTN CREDENTIALING | ||||||||
City: | WEST COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 291694810 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8039367679 | ||||||||
FaxNumber: | 8037912122 | ||||||||
Practice Location | |||||||||
Address1: | 3799 12TH STREET EXT STE 110 | ||||||||
Address2: |   | ||||||||
City: | CAYCE | ||||||||
State: | SC | ||||||||
PostalCode: | 290333750 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8037553337 | ||||||||
FaxNumber: | 8039552225 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/20/2007 | ||||||||
LastUpdateDate: | 10/01/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/01/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0106X | 2308 | SC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health |
No ID Information.