Healthcare Provider Details

I. General information

NPI: 1437785888
Provider Name (Legal Business Name): HUNTER TYSON CHESTNUT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 MAIN ST
CONWAY SC
29526-3572
US

IV. Provider business mailing address

1608 MAIN ST
CONWAY SC
29526-3572
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-4700
  • Fax:
Mailing address:
  • Phone: 843-248-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25202
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: