Active NPI
South Carolina Provider Services, LLC
- Adult Health Nurse Practitioner
- Clemson, SC
National Provider Identifier
1003413469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- Legal business name
- SOUTH CAROLINA PROVIDER SERVICES, LLC
- Practice address
- 500 Downs Loop
Clemson, SC 29631-2035 - Phone
- (864) 650-7475
- NPI assigned
- Oct 7, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gwendell McDaniel Kelley, APRN
- Title
- Owner
- Phone
- (864) 650-7475
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | Primary |
Addresses
Primary practice location
500 Downs Loop
Clemson, SC 29631-2035
Mailing address
200 Browning Rd
Central, SC 29630-9440
Phone (864) 650-7475
Other practice location 1
515 Benton St
Seneca, SC 29672-6883
Phone (864) 888-4114
Other practice location 2
107 Perpetual Sq
Anderson, SC 29621-1713
Phone (864) 712-4522
Other practice location 3
214 McGee Rd
Anderson, SC 29625-2104
Phone (864) 260-4515
Other practice location 4
123 Couch Ln
Easley, SC 29642-1916
Phone (864) 859-3303
Other practice location 5
999 W Union Rd
West Union, SC 29696-2642
Phone (864) 638-4370
Other practice location 6
701 Simpson Rd
Anderson, SC 29621-3077
Phone (864) 226-5505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210323002386 | SC | Part B Supplier - Clinic/Group Practice | 6305253139 |
Receives reassigned benefits from 1 practitioner Practice locations: Central, SC |
National Provider Directory
National Provider DirectoryLocations
123 Couch Ln
Easley, SC 29642
Phone (864) 397-0665
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Anderson, SC
- NPI 1558526384
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602028800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1776297600000",
"number": "1003413469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 BROWNING RD",
"city": "CENTRAL",
"state": "SC",
"postal_code": "296309440",
"telephone_number": "864-650-7475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 DOWNS LOOP",
"city": "CLEMSON",
"state": "SC",
"postal_code": "296312035",
"telephone_number": "864-650-7475"
}
],
"practiceLocations": [
{
"address_1": "515 Benton St",
"address_purpose": "LOCATION",
"city": "Seneca",
"state": "SC",
"postal_code": "296726883",
"country_code": "US",
"telephone_number": "864-888-4114",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "107 Perpetual Sq",
"address_purpose": "LOCATION",
"city": "Anderson",
"state": "SC",
"postal_code": "296211713",
"country_code": "US",
"telephone_number": "864-712-4522",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "214 McGee Rd",
"address_purpose": "LOCATION",
"city": "Anderson",
"state": "SC",
"postal_code": "296252104",
"country_code": "US",
"telephone_number": "864-260-4515",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "123 Couch Ln",
"address_purpose": "LOCATION",
"city": "Easley",
"state": "SC",
"postal_code": "296421916",
"country_code": "US",
"telephone_number": "864-859-3303",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "999 W Union Rd",
"address_purpose": "LOCATION",
"city": "West Union",
"state": "SC",
"postal_code": "296962642",
"country_code": "US",
"telephone_number": "864-638-4370",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "701 Simpson Rd",
"address_purpose": "LOCATION",
"city": "Anderson",
"state": "SC",
"postal_code": "296213077",
"country_code": "US",
"telephone_number": "864-226-5505",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "SOUTH CAROLINA PROVIDER SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-10-07",
"last_updated": "2026-04-16",
"certification_date": "2026-04-16",
"status": "A",
"authorized_official_last_name": "KELLEY",
"authorized_official_first_name": "GWENDELL",
"authorized_official_middle_name": "MCDANIEL",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "864-650-7475",
"authorized_official_credential": "APRN"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Adult Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clemson, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.