Individual
LATONI TIMESHA BETHEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Mailing address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23615
SC
363LG0600X
Gerontology Nurse Practitioner
23614
SC
363LG0600X
Gerontology Nurse Practitioner
5012875
NC
Other
Enumeration date
11/08/2019
Last updated
10/31/2022
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