Healthcare Provider Details

I. General information

NPI: 1962329714
Provider Name (Legal Business Name): LEAH-SHAY COOPER HUGHES AGACNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1279 GLENNS BAY RD
MYRTLE BEACH SC
29575-4723
US

IV. Provider business mailing address

1279 GLENNS BAY RD
MYRTLE BEACH SC
29575-4723
US

V. Phone/Fax

Practice location:
  • Phone: 843-215-0183
  • Fax:
Mailing address:
  • Phone: 843-215-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32265
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: