Provider Demographics
NPI:1154349710
Name:WALDROP, GAIL (ACNP-C)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:WALDROP
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NOBLE DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-4114
Mailing Address - Country:US
Mailing Address - Phone:864-446-3174
Mailing Address - Fax:
Practice Address - Street 1:115 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4053
Practice Address - Country:US
Practice Address - Phone:864-227-6641
Practice Address - Fax:864-227-3953
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5708Medicaid
SCNP0630Medicaid
SCNP0630Medicaid
SC9337Medicare PIN