Provider Demographics
NPI:1457798035
Name:HYNES, BEVERLY EDGAR (RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:EDGAR
Last Name:HYNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 SHELL SAND CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4347
Mailing Address - Country:US
Mailing Address - Phone:843-795-0498
Mailing Address - Fax:
Practice Address - Street 1:244 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-4742
Practice Address - Country:US
Practice Address - Phone:843-579-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC762954163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC762954Medicaid