Healthcare Provider Details

I. General information

NPI: 1437588712
Provider Name (Legal Business Name): BENITA BYARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 BASILDON RD
MOUNT PLEASANT SC
29466-7143
US

IV. Provider business mailing address

1007 BASILDON RD
MOUNT PLEASANT SC
29466-7143
US

V. Phone/Fax

Practice location:
  • Phone: 843-847-1688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number216003
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: