Provider Demographics
NPI:1437614880
Name:MEADOR, DAISY W (DNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:W
Last Name:MEADOR
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:MISS
Other - First Name:DAISY
Other - Middle Name:W
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:P.O. BOX 14611
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4611
Mailing Address - Country:US
Mailing Address - Phone:864-306-0966
Mailing Address - Fax:864-306-2544
Practice Address - Street 1:CORPORATE OFFICE
Practice Address - Street 2:3523 PELHAM RD, SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4191
Practice Address - Country:US
Practice Address - Phone:864-306-0966
Practice Address - Fax:864-306-2544
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6007Medicaid