| Traditions Health | |
|
115 Southport Rd Ste I Spartanburg SC 29306-3814 | |
| (864) 934-2798 | |
| Not Available |
| Full Name | Traditions Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 115 Southport Rd Ste I, Spartanburg, South Carolina |
| Authorized Official Name and Position | John Kerndl (CFO & SECRETARY) |
| Authorized Official Contact | 9797046547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Traditions Health 6840 Carothers Pkwy Ste 550 Franklin TN 37067-8002 Ph: (979) 704-6547 | Traditions Health 115 Southport Rd Ste I Spartanburg SC 29306-3814 Ph: (864) 934-2798 |
| NPI Number | 1982202693 |
|---|---|
| Provider Enumeration Date | 10/14/2020 |
| Last Update Date | 06/24/2024 |
| Medicare PECOS PAC ID | 3274944541 |
|---|---|
| Medicare Enrollment ID | O20201118002036 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982202693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Melody S Heffline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538291497 PECOS PAC ID: 0446303119 Enrollment ID: I20090728000292 |
| Provider Name | Ohmar Win |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1154527679 PECOS PAC ID: 3678611670 Enrollment ID: I20110405000983 |
| Provider Name | Ann E Reese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295037919 PECOS PAC ID: 5496939688 Enrollment ID: I20110413000213 |
| Provider Name | Bouvia Mcdaniel-jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033596580 PECOS PAC ID: 4688982358 Enrollment ID: I20150929002343 |
| Provider Name | Abraham James Weaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548695588 PECOS PAC ID: 4789813619 Enrollment ID: I20160309001793 |
| Provider Name | Cherika Stephanie Gadson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881077253 PECOS PAC ID: 8426363524 Enrollment ID: I20160816002256 |
| Provider Name | Clarissa Latoya Carelock-lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184075475 PECOS PAC ID: 7911293154 Enrollment ID: I20160914000881 |
| Provider Name | Yolanda Boyd-gantt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851953574 PECOS PAC ID: 5395074009 Enrollment ID: I20190905001763 |
| Provider Name | Lesley Styers Plowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841838869 PECOS PAC ID: 6002244407 Enrollment ID: I20200318001623 |
| Provider Name | Jamie Jeanette Tuttle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326656521 PECOS PAC ID: 9436562709 Enrollment ID: I20210105001439 |
| Provider Name | Jessica Mitchell Simpkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699444000 PECOS PAC ID: 5890184535 Enrollment ID: I20211117003089 |
| Provider Name | Tomeka D Payton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992085401 PECOS PAC ID: 5698036879 Enrollment ID: I20230112000629 |
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