Healthcare Provider Details

I. General information

NPI: 1619307956
Provider Name (Legal Business Name): FELICIA MINNIETTE HEYWARD DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2013
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 OXFORD ST STE C1
SUMTER SC
29150-3300
US

IV. Provider business mailing address

PO BOX 3149
SUMTER SC
29151-3149
US

V. Phone/Fax

Practice location:
  • Phone: 803-792-9002
  • Fax: 803-792-9006
Mailing address:
  • Phone: 803-792-9001
  • Fax: 803-792-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18597
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP18597
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0003237-C-NP
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18597
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: