Provider Demographics
NPI:1427037480
Name:AULTON, SANDRA DELOATCH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DELOATCH
Last Name:AULTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REDFERN HEALTH CENTER CLEMSON UNIVERSITY
Mailing Address - Street 2:735 MCMILLAN ROAD
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-4054
Mailing Address - Country:US
Mailing Address - Phone:864-656-2233
Mailing Address - Fax:864-656-0760
Practice Address - Street 1:REDFERN HEALTH CENTER CLEMSON UNIVERSITY
Practice Address - Street 2:735 MCMILLAN ROAD
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29634-4054
Practice Address - Country:US
Practice Address - Phone:864-656-2869
Practice Address - Fax:864-656-0760
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP485882363LA2200X
SCAPN2743363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN