Basic Information
| Provider Information | |||||||||
| NPI: | 1497857668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | MSN, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 TARRYTOWN LN | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291703525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037945535 | ||||||||
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| Practice Location | |||||||||
| Address1: | 298 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296729443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648857633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 922 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F922 | 01 | SC | PRESCRIPTIVE AUTHORITY | OTHER | NP0600 | 05 | SC | MEDICAID | 54-00274 | 01 | SC | SC CONTROL SUBSTANCE | OTHER | APN 922 | 01 | SC | STATE NURSING LICENSE | OTHER | MSO470512 | 01 | SC | DEA | OTHER |