Christine A Statom, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

P39793 Issued in SC

Practice address

10457 Highway 221 S
Waterloo, SC 29384-3910

Phone

(864) 677-4670

Fax

(864) 677-4674

NPI assigned

Dec 14, 2016

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

State licenses

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

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1336683192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10457 HIGHWAY 221 S",
            "city": "WATERLOO",
            "state": "SC",
            "postal_code": "293843910",
            "telephone_number": "864-677-4670",
            "fax_number": "864-677-4674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10457 HIGHWAY 221 S",
            "city": "WATERLOO",
            "state": "SC",
            "postal_code": "293843910",
            "telephone_number": "864-677-4670",
            "fax_number": "864-677-4674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATOM",
        "first_name": "CHRISTINE",
        "middle_name": "A",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-14",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "SC",
            "license": "P39793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolina Health Centers, Inc.
• Christine K Gray, MD
• Jane Workman Ivey, RPH
• Jennifer Ann Reynolds, RT/RCP
• Amanda Holman Smith, OTR/L
• Ronald Creswell Taylor, MA
• Brittny Terry
• Elcy Zimik, M.D.

• All providers in Waterloo, SC
• Licensed Practical Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; 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.