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Organization

SOUTH CAROLINA PROVIDER SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GWENDELL MCDANIEL KELLEY APRN (OWNER)
(864) 650-7475
Entity
Organization

Contact information

Practice address
500 DOWNS LOOP, CLEMSON, SC 29631-2035
(864) 650-7475
Mailing address
200 BROWNING RD, CENTRAL, SC 29630-9440
(864) 650-7475

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary

Other

Enumeration date
10/07/2020
Last updated
04/16/2026
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