Provider Demographics
NPI:1003205808
Name:BRAILSFORD, LATONYA (NP)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:BRAILSFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:142 WHISPERING PINES CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4945
Mailing Address - Country:US
Mailing Address - Phone:803-351-9405
Mailing Address - Fax:803-219-3836
Practice Address - Street 1:4605 MONTICELLO RD STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-4156
Practice Address - Country:US
Practice Address - Phone:803-753-5590
Practice Address - Fax:803-753-5592
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC26158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily