Individual
LISA CRESWELL MYRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7182 WOODROW ST STE 200, IRMO, SC 29063-2832
(803) 749-1111
(803) 749-0050
Mailing address
7182 WOODROW ST STE 200, IRMO, SC 29063-2832
(803) 749-1111
(803) 749-0050
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
8943
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MPA3202PA
SC PA LICENSE
SC
Enumeration date
09/18/2018
Last updated
02/26/2024
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