MEDICARE: KODY VAUGHN HANVEY ACNP

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	207R00000X	Internal Medicine Physician	31489	SC

General Provider Information

NPI Number	:	1861342057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KODY VAUGHN HANVEY ACNP

Provider Business Mailing Address
First Line	:	298 MEMORIAL DR
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29672-9443
Country	:	US
Telephone Number	:	864-455-1129
Fax Number	:	864-455-1129

Provider Business Practice Location Address
First Line	:	298 MEMORIAL DR
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29672-9499
Country	:	US
Telephone Number	:	864-455-1129
Fax Number	:	864-455-1129

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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