Provider Demographics
NPI:1407108954
Name:WHITTINGTON, VONNY
Entity Type:Individual
Prefix:
First Name:VONNY
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2411
Mailing Address - Country:US
Mailing Address - Phone:843-394-2031
Mailing Address - Fax:
Practice Address - Street 1:101 JOHN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2411
Practice Address - Country:US
Practice Address - Phone:843-394-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC363L00000XMedicaid
SC363L00000XMedicare Oscar/Certification
SC363L00000XMedicare UPIN
SC363L00000XMedicaid