Healthcare Provider Details

I. General information

NPI: 1518070531
Provider Name (Legal Business Name): SYLVIA MCKOY WATTS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIA MCKOY

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 HIGHWAY 15-401 E
MC COLL SC
29570-6128
US

IV. Provider business mailing address

PO BOX 1090
HARTSVILLE SC
29551-1090
US

V. Phone/Fax

Practice location:
  • Phone: 843-523-5751
  • Fax: 843-523-6040
Mailing address:
  • Phone: 843-857-0111
  • Fax: 843-857-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1392
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: