Provider Demographics
NPI:1548606007
Name:CHESTNUT, BRITTANY KEELER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:KEELER
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MR
Other - First Name:BRITTANY
Other - Middle Name:L
Other - Last Name:CHESTNUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 W MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2500
Practice Address - Country:US
Practice Address - Phone:803-358-6420
Practice Address - Fax:803-358-6450
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9999363AM0700X
SC1942363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1942OtherPRESCRIPTIVE AUTHORITY
SCMPA 1942 PAOtherSC MEDICAL LICENSE
SCMPA 1942 PAOtherSC MEDICAL LICENSE
SCMPA 1942 PAOtherSC MEDICAL LICENSE