Provider Demographics
NPI:1528689635
Name:HEADLEY, CHRISTOPHER DAVID (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:HEADLEY
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 OPHELIA WAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-6784
Mailing Address - Country:US
Mailing Address - Phone:614-395-0806
Mailing Address - Fax:
Practice Address - Street 1:2887 OPHELIA WAY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6784
Practice Address - Country:US
Practice Address - Phone:614-395-0806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC243988163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health