Healthcare Provider Details

I. General information

NPI: 1821714965
Provider Name (Legal Business Name): SHARONDA RAWLS LEGETTE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 LATIMER ST
LATTA SC
29565-1828
US

IV. Provider business mailing address

PO BOX 1090
HARTSVILLE SC
29551-1090
US

V. Phone/Fax

Practice location:
  • Phone: 843-627-6252
  • Fax: 843-627-6271
Mailing address:
  • Phone: 843-857-0111
  • Fax: 843-309-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26266
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: