Healthcare Provider Details

I. General information

NPI: 1457798035
Provider Name (Legal Business Name): BEVERLY EDGAR HYNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 PRESIDENT ST
CHARLESTON SC
29403-4742
US

IV. Provider business mailing address

789 SHELL SAND CIR
CHARLESTON SC
29412-4347
US

V. Phone/Fax

Practice location:
  • Phone: 843-579-4820
  • Fax:
Mailing address:
  • Phone: 843-795-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number762954
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: