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NPI 1760172381ActiveIndividual· Nurse Practitioner· Fort Mill, SC

Nurse Practitioner in Fort Mill, South Carolina, licensed in SC and IL, with an NPI issued in May 2023.

Overview

NPI1760172381
StatusActive
Entity typeIndividual
Sole proprietorNo
NPI issuedMay 8, 2023
Last updated in NPPESNov 13, 2023
Certified by providerNov 13, 2023

Specialties and licenses

TaxonomyCodeLicenseState
Nurse Practitioner Primary363L00000X27682SC
Nurse Practitioner, Adult Health363LA2200X209027103IL

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 10, 2026No match—
New York OMIG · Nov 10, 2026No match—
Ohio Medicaid · Nov 10, 2026No match—
Pennsylvania Medicheck · Nov 10, 2026No match—
Washington HCA · Nov 10, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Not in the public enrollment file of Oct 1, 2026

Medicare sources and data years

Industry payments (Open Payments)

None reported for 2025 or 2024.

Receiving payments does not imply wrongdoing. What Open Payments covers ·original records

Other Nurse Practitioner providers in Fort Mill

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