Provider Demographics
NPI:1720112618
Name:CASHWELL, GWENDOLYN GRAY (NP)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:GRAY
Last Name:CASHWELL
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:GRAY
Other - Last Name:GIRDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1175 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8201
Mailing Address - Country:US
Mailing Address - Phone:803-395-3835
Mailing Address - Fax:803-395-4251
Practice Address - Street 1:1175 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:803-395-3835
Practice Address - Fax:803-395-4251
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6316Medicaid