Active NPI
Stephanie H Tetterton, PA
- Otolaryngology Physician
- Lugoff, SC
National Provider Identifier
1154339695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 860
- Practice address
- 15 Exchange Dr
Lugoff, SC 29078-9198 - Phone
- (803) 408-3277
- Fax
- (803) 408-3282
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 860 | SC | Primary |
Addresses
Primary practice location
15 Exchange Dr
Lugoff, SC 29078-9198
Mailing address
PO Box 520
Lugoff, SC 29078-0520
Phone (803) 408-3277
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 860 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 860 | SC | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316649600000",
"number": "1154339695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 520",
"city": "LUGOFF",
"state": "SC",
"postal_code": "290780520",
"telephone_number": "803-408-3277",
"fax_number": "803-408-3282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 EXCHANGE DR",
"city": "LUGOFF",
"state": "SC",
"postal_code": "290789198",
"telephone_number": "803-408-3277",
"fax_number": "803-408-3282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETTERTON",
"first_name": "STEPHANIE",
"middle_name": "H",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-03",
"last_updated": "2011-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "SC",
"license": "860",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "860",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lugoff, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.