Individual
AYESHA MONAY MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
2611 FOREST DR STE 200, COLUMBIA, SC 29204-2371
(803) 779-3263
(803) 779-3207
Mailing address
2611 FOREST DR STE 200, COLUMBIA, SC 29204-2371
(037) 793-2638
(803) 779-3207
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
APN.29792
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
319785
NC BOARD OF NURSING
NC
01
—
95074286
CA BOARD OF NURSING
CA
Enumeration date
10/27/2022
Last updated
01/03/2025
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