Provider Demographics
NPI:1275948838
Name:HINTON NUTT, AYESHA SHAVON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AYESHA
Middle Name:SHAVON
Last Name:HINTON NUTT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AYESHA
Other - Middle Name:SHAVON
Other - Last Name:HINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8617
Mailing Address - Fax:
Practice Address - Street 1:357 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3415
Practice Address - Country:US
Practice Address - Phone:864-522-8350
Practice Address - Fax:864-522-8359
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2875Medicaid