1932726007 NPI number — TIFFANY WEEKS MYERS APRN, FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932726007 NPI number — TIFFANY WEEKS MYERS APRN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
TIFFANY
Provider Middle Name:
WEEKS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEEKS
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
SHANIKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932726007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1330 DUTCH FORK ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLENTINE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-749-1666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 DUTCH FORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLENTINE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29002-0568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-1666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  23765 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F12190057 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23765 . This is a "APRN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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