Basic Information
| Provider Information | |||||||||
| NPI: | 1154309490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDRY | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 SOUTH PIKE WEST | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291502664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037744981 | ||||||||
| FaxNumber: | 8037744993 | ||||||||
| Practice Location | |||||||||
| Address1: | 370 SOUTH PIKE WEST | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291502664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037746448 | ||||||||
| FaxNumber: | 8037748299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | RN350608L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.