Healthcare Provider Details

I. General information

NPI: 1801166277
Provider Name (Legal Business Name): COURTNEY SANDIFER HUTTO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 02/13/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E MAIN STREET
BARNWELL SC
29812-1529
US

IV. Provider business mailing address

228 E MAIN STREET 228 E MAIN STREET
BARNWELL SC
29812-1529
US

V. Phone/Fax

Practice location:
  • Phone: 803-709-7778
  • Fax: 803-709-7781
Mailing address:
  • Phone: 803-709-7778
  • Fax: 803-709-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17697
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: