Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mirakle Avery

Individual provider Physician Assistant · NPI 1013772391

Mirakle Avery is a Physician Assistant in Columbia, South Carolina. Graduated from Medical University of South Carolina College of Medicine in 2025, 1 year ago. Accepts Medicare assignment. Licensed in South Carolina.

Years since qualifying
1
Trained at
Medical University of South Carolina College of Medicine
Licensed in
SC
In the registry since
2024
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Practice location Address checks out

2611 Forest Dr Ste 200
Columbia, SC 29204-2371
Phone: (803) 799-3263
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 6095 (SC)

Record details

NPI number1013772391
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 16, 2024
Last updated in NPPESJanuary 15, 2026
Certification dateJanuary 15, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Columbia