Healthcare Provider Details

I. General information

NPI: 1194662437
Provider Name (Legal Business Name): LAURYN CLAIRE HUTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DOCTORS DR
GREENVILLE SC
29605-5622
US

IV. Provider business mailing address

8 CHEEKWOOD CT
SIMPSONVILLE SC
29680-7082
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-7150
  • Fax: 864-797-7029
Mailing address:
  • Phone: 864-385-4964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: