MEDICARE: KRYSTA CARHART 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	363LF0000X	Family Nurse Practitioner	0024196489	VA
2	363LF0000X	Family Nurse Practitioner	CNP261054	ME
3	363LF0000X	Family Nurse Practitioner	27170	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27170	OTHER	SC	SC BOARD OF NURSING

General Provider Information

NPI Number	:	1679273460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTA CARHART FNP-C

Provider Business Mailing Address
First Line	:	1035 OLD CYPRESS RUN
Second Line	:
City	:	HANAHAN
State	:	SC
Zip	:	29410-8300
Country	:	US
Telephone Number	:	843-991-5471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BISHOP GADSDEN WAY STE 97
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3506
Country	:	US
Telephone Number	:	843-406-2362
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	04/03/2026

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