Provider Demographics
NPI:1346069408
Name:SIMS, EVELYN FERSHORN (CMA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:FERSHORN
Last Name:SIMS
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PACES RUN CT APT 116
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7944
Mailing Address - Country:US
Mailing Address - Phone:803-741-6377
Mailing Address - Fax:
Practice Address - Street 1:100 PACES RUN CT APT 116
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7944
Practice Address - Country:US
Practice Address - Phone:803-261-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10143944374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide