Provider Demographics
NPI:1518070531
Name:MCKOY WATTS, SYLVIA (NP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MCKOY WATTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:MCKOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1090
Mailing Address - Country:US
Mailing Address - Phone:843-857-0111
Mailing Address - Fax:843-857-0206
Practice Address - Street 1:3080 HIGHWAY 15-401 E
Practice Address - Street 2:
Practice Address - City:MC COLL
Practice Address - State:SC
Practice Address - Zip Code:29570-6128
Practice Address - Country:US
Practice Address - Phone:843-523-5751
Practice Address - Fax:843-523-6040
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0658Medicaid
SCSC6257OtherMEDICARE
SCP00906547OtherRAILROAD MEDICARE PTAN
SCSC6257Medicare UPIN
SCNP0658Medicaid
SCP551896674Medicare PIN
SCP5518967415Medicare PIN
SCP55189Medicare UPIN