Healthcare Provider Details

I. General information

NPI: 1740011618
Provider Name (Legal Business Name): LATOYA LYNNETTE JOHNSON SELLERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 09/20/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 COMMERCE DRIVE
DILLON SC
29536
US

IV. Provider business mailing address

PO BOX 918
BENNETTSVILLE SC
29512-0918
US

V. Phone/Fax

Practice location:
  • Phone: 843-774-3351
  • Fax: 843-774-2622
Mailing address:
  • Phone: 843-544-4060
  • Fax: 843-454-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number262674
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number262674
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: