Provider Demographics
NPI:1902874860
Name:SCHILDKNECHT, FARRAH (RN, NP)
Entity type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:
Last Name:SCHILDKNECHT
Suffix:
Gender:F
Credentials:RN, NP
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 22265
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4473
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR STE 200
Practice Address - Street 2:14 MEDICAL PARK SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6882
Practice Address - Country:US
Practice Address - Phone:803-227-8000
Practice Address - Fax:803-227-8015
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC075211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC075211Medicaid
SC570521956OtherEMPLOYER ID#
SCP51076Medicare UPIN
SCP510761314Medicare UPIN
SC075211Medicaid