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NPI Code Detail

MEDICARE: MRS. AVIANCE CHANTAL PANKEY NP

MEDICARE: MRS. AVIANCE CHANTAL PANKEY NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner31042SC
2363LP0808XPsychiatric/Mental Health Nurse Practitioner0024192635VA

General Provider Information

NPI Number : 1053116368
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AVIANCE CHANTAL PANKEY NP
Provider Business Mailing Address
First Line : 3600 FOREST DR STE 302
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-4057
Country : US
Telephone Number : 803-699-8887
Fax Number : 803-699-8824
Provider Business Practice Location Address
First Line : 2528 LAS BRISAS DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456-4264
Country : US
Telephone Number : 757-689-0334
Fax Number : 757-689-0350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2025
Last Update Date : 02/06/2026

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