Provider Demographics
NPI:1598461915
Name:HYATT, VICTORIA WRIGHT (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:WRIGHT
Last Name:HYATT
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 OLD CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9725
Mailing Address - Country:US
Mailing Address - Phone:803-530-5800
Mailing Address - Fax:
Practice Address - Street 1:141 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7066
Practice Address - Country:US
Practice Address - Phone:803-520-9261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.27046363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics