Individual provider Active NPI

Paulette Beverly Brown

  • Psychiatric/Mental Health Nurse Practitioner
  • Clinton, SC
National Provider Identifier
1598099681
Registry record updated Oct 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
27110 Issued in SC
Practice address
939 Springdale Dr
Clinton, SC 29325-7266
Phone
(910) 742-9243
Fax
(888) 746-1787
NPI assigned
Sep 23, 2009
Last updated
Oct 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 27110 SC Primary
Registered Nurse 163W00000X RN104253 GA

Addresses

Primary practice location

939 Springdale Dr
Clinton, SC 29325-7266

Mailing address

304 Wheatfield CT
Travelers Rest, SC 29690-7953
Phone (706) 910-4857

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251125004500 SC Practitioner - Nurse Practitioner 3971095084 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifesource of North CarolinaGroup PAC ID 7416132428, 172 clinicians

Practice addresses (Care Compare)

939 Springdale Dr
Clinton, SC 29325-7266
Phone (910) 742-9243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN104253GAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesource Prime Inc CurrentSince Nov 15, 2025 Accepting new patients
Lifesource of North Carolina Psychiatric/Mental Health CurrentSince Nov 15, 2025 Accepting new patients
Lifesource Prime Inc CurrentSince Nov 15, 2025 Accepting new patients
Lifesource of North Carolina CurrentSince Nov 15, 2025 Accepting new patients

Locations

1915 Ebenezer Rd
Rock Hill, SC 29732
Phone (305) 866-9951

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760745600000",
    "number": "1598099681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 WHEATFIELD CT",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296907953",
            "telephone_number": "706-910-4857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 SPRINGDALE DR",
            "city": "CLINTON",
            "state": "SC",
            "postal_code": "293257266",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "PAULETTE",
        "middle_name": "BEVERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-23",
        "last_updated": "2025-10-18",
        "certification_date": "2025-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "27110",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN104253",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, SC

Sources for this page

Verify at the official NPI Registry.