Healthcare Provider Details

I. General information

NPI: 1104064377
Provider Name (Legal Business Name): HEATHER CAUSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 02/15/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3558 OLD REAVES FERRY RD
CONWAY SC
29526-7318
US

IV. Provider business mailing address

3562 OLD REAVES FERRY RD
CONWAY SC
29526-7318
US

V. Phone/Fax

Practice location:
  • Phone: 843-602-3892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number93190
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number93190
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: