Provider Demographics
NPI:1801166277
Name:HUTTO, COURTNEY SANDIFER (FNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SANDIFER
Last Name:HUTTO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E MAIN STREET
Mailing Address - Street 2:228 E MAIN STREET
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1529
Mailing Address - Country:US
Mailing Address - Phone:803-709-7778
Mailing Address - Fax:803-709-7781
Practice Address - Street 1:228 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1529
Practice Address - Country:US
Practice Address - Phone:803-709-7778
Practice Address - Fax:803-709-7781
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17697363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA8400OtherMEDICARE
SC17697OtherMEDICAL LICENSE
SCNP2018Medicaid