Healthcare Provider Details

I. General information

NPI: 1134890064
Provider Name (Legal Business Name): WHITNEY ELISE JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 PAMPLICO HWY STE B300
FLORENCE SC
29505-6081
US

IV. Provider business mailing address

PO BOX 935722
ATLANTA GA
31193-5722
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-7529
  • Fax: 843-673-7532
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number25201
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: