Provider Demographics
NPI:1447792197
Name:LOVELL, MISTY (CPNP)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:LOVELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:MISTY
Other - Middle Name:DANIELL
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:151 BEREA MIDDLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-1220
Practice Address - Country:US
Practice Address - Phone:864-454-2341
Practice Address - Fax:864-454-1114
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014979363LP0200X
SC22822363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics