Provider Demographics
NPI:1306732631
Name:GEDDES, VASTI ORTEGA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VASTI
Middle Name:ORTEGA
Last Name:GEDDES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 AQUINAS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-0180
Mailing Address - Country:US
Mailing Address - Phone:910-441-8054
Mailing Address - Fax:
Practice Address - Street 1:1188 STONECREST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6633
Practice Address - Country:US
Practice Address - Phone:803-233-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPENDING363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health