Individual
ALLYSON DERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 MEDICAL PARK RD STE 302, COLUMBIA, SC 29203-6839
(803) 434-8820
(803) 254-0821
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 695-6697
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
24420
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP7372
—
SC
Enumeration date
05/11/2020
Last updated
10/02/2024
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