Individual
VICKIE GLOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13649 CHURCH STREET, WILLISTON, SC 29853
(803) 266-0060
(803) 266-0042
Mailing address
86 WREN STREET, BARNWELL, SC 29812
(803) 259-5762
(803) 259-3050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00047961
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0020PA
—
SC
01
—
P19236
MEDICARE
SC
Enumeration date
07/27/2006
Last updated
01/11/2024
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