MEDICARE: MR. WILLIAM JENNINGS LAUGHERTY JR. FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4292	SC

General Provider Information

NPI Number	:	1174839096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JENNINGS LAUGHERTY JR. FNP

Provider Business Mailing Address
First Line	:	204 W HILL BLVD
Second Line	:	BLDG 364 RM 2056
City	:	CHARLESTON
State	:	SC
Zip	:	29404-4704
Country	:	US
Telephone Number	:	865-250-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W HILL BLVD
Second Line	:	BLDG 364 RM 2056
City	:	CHARLESTON
State	:	SC
Zip	:	29404-4704
Country	:	US
Telephone Number	:	865-250-5805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	05/02/2025

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