Individual
MS. STACY SMITH NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1509 HAVILAND CIR, COLUMBIA, SC 29210-4051
(518) 491-0012
Mailing address
PO BOX 366, IRMO, SC 29063-0366
(518) 491-0012
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
174400000X
Specialist
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
05/19/2025
Last updated
05/19/2025
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