Provider Demographics
NPI:1386341121
Name:ROULSTON, ABIGAIL (APRN)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:ROULSTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-791-3494
Mailing Address - Fax:803-739-9854
Practice Address - Street 1:3314 PLATT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2204
Practice Address - Country:US
Practice Address - Phone:803-791-3494
Practice Address - Fax:803-739-9854
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily