Virginia Pettway, DNP, PNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

28786 Issued in SC

Practice address

1995 Saint Matthews Rd
Orangeburg, SC 29118-2405

Phone

(803) 928-5525

NPI assigned

May 24, 2024

Last updated

May 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Medical Management, LLC

  dba SouthernMED Counseling

  • Pediatrics Physician
  • Lexington, SC
  • NPI 1114196557
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1164261426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 YEADON AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077327",
            "telephone_number": "423-802-7524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 SAINT MATTHEWS RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291182405",
            "telephone_number": "803-928-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTWAY",
        "first_name": "VIRGINIA",
        "credential": "DNP, PNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-24",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "SC",
            "license": "28786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ben C Pendarvis Jr., M.D.
• Vincent Pendarvis, M.ED
• Boris Penev, DO
• Sara Rose Peters, PA-C
• Matthew Seth Petitt, MD
• Amy Quynh-Trang Pham, MD
• Physicians Footcare Orangeburg LLC
• Pickering Prosthetics
• Alvin W. Pickering, C.P.,R.O.F.
• Pilot Club of Orangeburg Foundation

• Pediatric Nurse Practitioner in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Pediatric Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.