Healthcare Provider Details

I. General information

NPI: 1396110599
Provider Name (Legal Business Name): ASHLEY A. HARRELL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 CHESTNUT RD
MYRTLE BEACH SC
29572-5502
US

IV. Provider business mailing address

630 CHESTNUT RD
MYRTLE BEACH SC
29572-5502
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-1452
  • Fax: 843-945-1489
Mailing address:
  • Phone: 843-945-1452
  • Fax: 843-945-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19880
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19880
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: