Individual
MISS MICAH RAVEN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2200 CROW LN, MYRTLE BEACH, SC 29577-1663
(843) 848-5300
Mailing address
2200 CROW LN, MYRTLE BEACH, SC 29577-1663
(843) 504-2747
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
27540
SC
Other
Enumeration date
07/05/2023
Last updated
07/10/2023
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