Healthcare Provider Details

I. General information

NPI: 1760348072
Provider Name (Legal Business Name): CHYNA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 JASMINE DR
CONWAY SC
29527-5912
US

IV. Provider business mailing address

316 JASMINE DR
CONWAY SC
29527-5912
US

V. Phone/Fax

Practice location:
  • Phone: 843-359-8174
  • Fax:
Mailing address:
  • Phone: 843-359-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1366033
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: