MEDICARE: MRS. CHRYSTAL ELAINE RHODES-WALLS FNP-C

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	27369	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467628503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRYSTAL ELAINE RHODES-WALLS FNP-C

Provider Business Mailing Address
First Line	:	3009 CHURCH ST STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5983
Country	:	US
Telephone Number	:	800-932-2738
Fax Number	:	888-847-9306

Provider Business Practice Location Address
First Line	:	3009 CHURCH ST STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5983
Country	:	US
Telephone Number	:	800-932-2738
Fax Number	:	888-847-9306

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	07/26/2023

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