Active NPI
Tammy Prockiw, PA
- Physician Assistant
- Mt Pleasant, SC
National Provider Identifier
1295554459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 4165
- Practice address
- 1031 Chuck Dawley Blvd Ste 3
Mt Pleasant, SC 29464-4188 - Phone
- (843) 425-6526
- NPI assigned
- Oct 5, 2024
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4165 | SC | Primary |
Addresses
Primary practice location
1031 Chuck Dawley Blvd Ste 3
Mt Pleasant, SC 29464-4188
Mailing address
1031 Chuck Dawley Blvd Ste 3
Mt Pleasant, SC 29464-4188
Phone (843) 425-6526
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4165 | SC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728086400000",
"number": "1295554459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1031 CHUCK DAWLEY BLVD STE 3",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294644188",
"telephone_number": "843-425-6526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1031 CHUCK DAWLEY BLVD STE 3",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294644188",
"telephone_number": "843-425-6526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCKIW",
"first_name": "TAMMY",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-05",
"last_updated": "2024-10-05",
"certification_date": "2024-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "4165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.