Provider Demographics
NPI:1194721472
Name:FAULKENBERRY, WARD M (CFNP)
Entity type:Individual
Prefix:MR
First Name:WARD
Middle Name:M
Last Name:FAULKENBERRY
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MEETING ST
Mailing Address - Street 2:STE A
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2380
Mailing Address - Country:US
Mailing Address - Phone:803-286-4666
Mailing Address - Fax:803-289-6591
Practice Address - Street 1:201 W MEETING ST
Practice Address - Street 2:STE A
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2380
Practice Address - Country:US
Practice Address - Phone:803-286-4666
Practice Address - Fax:803-289-6591
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF27646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHP0385Medicaid
SCHP0385Medicaid