MEDICARE: COURTNEY ALEXANDRA HATCHELL

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
1	363L00000X	Nurse Practitioner	257897	SC

General Provider Information

NPI Number	:	1083439350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ALEXANDRA HATCHELL

Provider Business Mailing Address
First Line	:	1404 S 4TH ST
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-7449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 S 4TH ST
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-7449
Country	:	US
Telephone Number	:	843-307-7851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	02/25/2026

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