Provider Demographics
NPI:1235755984
Name:WARD, CHASIDY LYNN (APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CHASIDY
Middle Name:LYNN
Last Name:WARD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:CHASIDY
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:376 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4418
Mailing Address - Country:US
Mailing Address - Phone:843-799-0642
Mailing Address - Fax:
Practice Address - Street 1:4591 SOCASTEE BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7209
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:866-778-9611
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF06201365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW6078136OtherDEA
SCXW6078136OtherX-NUMBER DEA