Active NPI
Addie Moultrie
- Registered Nurse
- Lexington, SC
National Provider Identifier
1265838486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 49640
- Practice address
- 301 Palmetto Park Blvd
Lexington, SC 29072-7872 - Phone
- (803) 996-1500
- NPI assigned
- Nov 16, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 49640 | SC | Primary |
Addresses
Primary practice location
301 Palmetto Park Blvd
Lexington, SC 29072-7872
Mailing address
1018 Pine St
Cayce, SC 29033-3408
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49640 | SC | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416096000000",
"number": "1265838486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1018 PINE ST",
"city": "CAYCE",
"state": "SC",
"postal_code": "290333408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 PALMETTO PARK BLVD",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290727872",
"telephone_number": "803-996-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULTRIE",
"first_name": "ADDIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-16",
"last_updated": "2014-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "SC",
"license": "49640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.