Provision Healthcare, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

BL015940-07-2018 Issued in SC

Legal business name

PROVISION HEALTHCARE, LLC

Practice address

1320 Main St Ste 300
Columbia, SC 29201-3266

Phone

(803) 373-0063

NPI assigned

Jul 8, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Lashonda S Tyler, NP

Title

Owner

Phone

(803) 302-8205

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1531008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531008000000",
    "number": "1669968152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4611 HARD SCRABBLE RD STE 178",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292298584",
            "telephone_number": "803-302-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MAIN ST STE 300",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292013266",
            "telephone_number": "803-373-0063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10120 Two Notch Rd # 133",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292234395",
            "country_code": "US",
            "telephone_number": "803-373-0063",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4611 Hard Scrabble Rd Ste 178",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292298584",
            "country_code": "US",
            "telephone_number": "803-373-0063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVISION HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-08",
        "last_updated": "2018-07-08",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "LASHONDA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-302-8205",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "BL015940-07-2018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Columbia, SC
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2018; 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.