Provider Demographics
NPI:1821714965
Name:LEGETTE, SHARONDA RAWLS (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHARONDA
Middle Name:RAWLS
Last Name:LEGETTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-7238
Mailing Address - Country:US
Mailing Address - Phone:843-450-2916
Mailing Address - Fax:
Practice Address - Street 1:122 LATIMER ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1828
Practice Address - Country:US
Practice Address - Phone:843-627-6252
Practice Address - Fax:843-627-6271
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCO621OtherMEDICARE
SCNP8996Medicaid