Provider Demographics
NPI:1396799631
Name:STEPHENS, CHARLOTTE HATCHELL (APRN, DNP, FNP)
Entity type:Individual
Prefix:MISS
First Name:CHARLOTTE
Middle Name:HATCHELL
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:APRN, DNP, FNP
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:STEPHENS
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:391 SERPENTINE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3096
Practice Address - Country:US
Practice Address - Phone:864-560-7517
Practice Address - Fax:864-560-7520
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCA4266067OtherMEDICARE PIN
SCNP0868Medicaid
SCSCA4266121OtherMEDICARE PIN
SCSCA4266121OtherMEDICARE PIN
SCSCA4266067OtherMEDICARE PIN