Provider Demographics
NPI:1861427312
Name:SMITH, PATRICIA P (CNM)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1175 COOK ROAD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-531-2300
Mailing Address - Fax:803-531-0133
Practice Address - Street 1:1175 COOK ROAD
Practice Address - Street 2:SUITE 145
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118
Practice Address - Country:US
Practice Address - Phone:803-531-2300
Practice Address - Fax:803-531-0133
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC28681367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC166654OtherUNISON
SCMW0004Medicaid
SC621976OtherSELECT HEALTH
SC621976OtherSELECT HEALTH
SCMW0004Medicaid