Prudence Melinda Olsen, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

271 Issued in SC

Practice address

1120 Glenns Bay Rd
Surfside Beach, SC 29575-4757

Phone

(843) 215-5492

Fax

(843) 215-5512

NPI assigned

Sep 24, 2012

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

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Strand Regional Specialty

  • Multi-Specialty Clinic/Center
  • Murrells Inlet, SC
  • NPI 1023052354
  NPD (past)
• Strand Regional Specialty

  • Multi-Specialty Clinic/Center
  • Little River, SC
  • NPI 1225055288
  NPD (past)

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

{
    "created_epoch": "1348444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348444800000",
    "number": "1619228145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1552 HEATHMUIR DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295755370",
            "telephone_number": "843-995-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 GLENNS BAY RD",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295754757",
            "telephone_number": "843-215-5492",
            "fax_number": "843-215-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "PRUDENCE",
        "middle_name": "MELINDA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-24",
        "last_updated": "2012-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Daniel A Oehler, PA
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• Grishma Pankhania
• John L. Pavy, DDS
• PC Martin Chiropractic Inc
• Jabe Thomas Peele
• Anthony Corey Perella, DPT

• Medical Physician Assistant in Surfside Beach, SC
• Providers in Surfside Beach, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; 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.