Active NPI
Laketa McCormick
- Adult Companion
- Kingstree, SC
National Provider Identifier
1417734757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 7 Winchester Rd
Kingstree, SC 29556-5772 - Phone
- (803) 977-4652
- NPI assigned
- Sep 11, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | Primary |
Addresses
Primary practice location
7 Winchester Rd
Kingstree, SC 29556-5772
Mailing address
7 Winchester Rd
Kingstree, SC 29556-5772
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588345383 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694390400000",
"number": "1417734757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 WINCHESTER RD",
"city": "KINGSTREE",
"state": "SC",
"postal_code": "295565772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 WINCHESTER RD",
"city": "KINGSTREE",
"state": "SC",
"postal_code": "295565772",
"telephone_number": "803-977-4652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "LAKETA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-11",
"last_updated": "2023-09-11",
"certification_date": "2023-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1588345383",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingstree, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.