Healthcare Provider Details

I. General information

NPI: 1316451032
Provider Name (Legal Business Name): CHELSEA GORE HARDEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E STE 220
LITTLE RIVER SC
29566-8164
US

IV. Provider business mailing address

7979 BIRCHFIELD DR
LORIS SC
29569-5401
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-9774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21618
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230304
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: