Healthcare Provider Details

I. General information

NPI: 1235822453
Provider Name (Legal Business Name): LOREY STEVENS A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 SOCASTEE BLVD
MYRTLE BEACH SC
29588-7206
US

IV. Provider business mailing address

3695 TRAVIANA RD
CONWAY SC
29526-6098
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-1137
  • Fax:
Mailing address:
  • Phone: 610-417-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28429
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: