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:
Other - Last Name Type:
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 1:142 WHISPERING PINES CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-4945
Practice Address - Country:US
Practice Address - Phone:803-351-9405
Practice Address - Fax:803-219-3836
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily