Anida Lisa Phommatha

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

285084 Issued in SC

Practice address

1106 Cavil Hollins CT
Florence, SC 29501-9437

Phone

(303) 435-4233

NPI assigned

Sep 25, 2026

Last updated

Sep 25, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1790294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790294400000",
    "number": "1174436570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 CAVIL HOLLINS CT",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295019437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 CAVIL HOLLINS CT",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295019437",
            "telephone_number": "303-435-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOMMATHA",
        "first_name": "ANIDA",
        "middle_name": "LISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-09-25",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "285084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Florence, SC
• Providers in Florence, SC by specialty
• Registered Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.