Healthcare Provider Details

I. General information

NPI: 1154872919
Provider Name (Legal Business Name): CIELITA K. HALYARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SPRINGHALL DR
GOOSE CREEK SC
29445-5368
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-266-2520
  • Fax: 843-553-4436
Mailing address:
  • Phone: 843-695-6071
  • Fax: 843-569-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20529
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: