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General NPI Number Information
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NPI Number | 1639825979
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Entity Type | Individual
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Provider Name | DAMAR DEXTER UTER FNP-C, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1203 48TH AVE N STE 202
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5425
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Country | US
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Telephone | 843-449-2576
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 48TH AVE N STE 202
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5425
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Country | US
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Telephone | 843-449-2576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 27729
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 27729
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2022004331
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License Number State | MO
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