Provider Demographics
NPI:1104474238
Name:DUCK, MAMIE
Entity type:Individual
Prefix:
First Name:MAMIE
Middle Name:
Last Name:DUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207A N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4204
Mailing Address - Country:US
Mailing Address - Phone:803-316-4571
Mailing Address - Fax:803-938-5443
Practice Address - Street 1:207A N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4204
Practice Address - Country:US
Practice Address - Phone:803-938-5898
Practice Address - Fax:803-938-5443
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC004399164X00000X
251J00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
044139OtherNURSE LICENSED
SC3014415Medicaid
SC3014415OtherWE KARE HOME CARE AGENCY