Healthcare Provider Details

I. General information

NPI: 1396236170
Provider Name (Legal Business Name): NATASHA THAISA WEATHERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 11/08/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9313 MEDICAL PLAZA DR STE 103
N CHARLESTON SC
29406-9802
US

IV. Provider business mailing address

9313 MEDICAL PLAZA DR STE 103
N CHARLESTON SC
29406-9802
US

V. Phone/Fax

Practice location:
  • Phone: 843-790-8280
  • Fax: 843-974-8500
Mailing address:
  • Phone: 843-790-8280
  • Fax: 843-974-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21860
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: