Provider Demographics
NPI:1902953201
Name:HARRELSON, SYBIL C (NPP)
Entity type:Individual
Prefix:MRS
First Name:SYBIL
Middle Name:C
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:MISS
Other - First Name:SYBIL
Other - Middle Name:M
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4630
Mailing Address - Country:US
Mailing Address - Phone:864-235-7655
Mailing Address - Fax:864-233-5971
Practice Address - Street 1:1005 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4630
Practice Address - Country:US
Practice Address - Phone:864-235-7665
Practice Address - Fax:864-233-5971
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAC77363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0975Medicaid
SC4695Medicare ID - Type Unspecified
SCGP0975Medicaid
SC8157Medicare PIN