MEDICARE: VONNY WHITTINGTON

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	18011	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1407108954	OTHER		OCC HEALTH WORK SITE

General Provider Information

NPI Number	:	1407108954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONNY WHITTINGTON

Provider Business Mailing Address
First Line	:	1075 STATE HWY 247
Second Line	:
City	:	CORONA
State	:	NM
Zip	:	88318
Country	:	US
Telephone Number	:	803-720-1817
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 JOHN ST
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2411
Country	:	US
Telephone Number	:	843-394-2031
Fax Number	:

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	05/17/2024

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Directions to “ VONNY WHITTINGTON ” Practice Location

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