Healthcare Provider Details

I. General information

NPI: 1245948041
Provider Name (Legal Business Name): RENEE ELLEN WALTER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE ELLEN QUIGLEY

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 FORT HILL WAY
MYRTLE BEACH SC
29579-3743
US

IV. Provider business mailing address

9151 FORT HILL WAY
MYRTLE BEACH SC
29579-3743
US

V. Phone/Fax

Practice location:
  • Phone: 843-632-8882
  • Fax: 843-632-8883
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27384
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27384
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: