Latova Nichelle Quattlebaum, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

21979 Issued in SC

Practice address

1228 Harden St Ste B
Columbia, SC 29204-1800

Phone

(803) 733-5969

Fax

(803) 753-5591

NPI assigned

Sep 10, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lquattlebaum413528@direct.ghs.myhfn.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prisma Health Medical Group-Midlands

  • Multi-Specialty Clinic/Center
  • Columbia, SC
  • NPI 1275988321
  Medicare reassignment Care Compare group NPD
• Eau Claire Cooperative Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
  • NPI 1346249430
  Medicare reassignment NPD
• Eau Claire Cooperative Health Center ,Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
  • NPI 1588375653
  NPD
• Eau Claire Cooperative Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
  • NPI 1427494392
  NPD
• Prisma Health Medical Group-Midlands

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia, SC
  • NPI 1417442864
  NPD
• Prisma Health Medical Group-Midlands

  • Durable Medical Equipment & Medical Supplies
  • Columbia, SC
  • NPI 1881469856
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1659854255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3788",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292303788",
            "telephone_number": "803-733-5969",
            "fax_number": "803-753-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 HARDEN ST STE B",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292041800",
            "telephone_number": "803-733-5969",
            "fax_number": "803-753-5591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Taylor St Ste J",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292012942",
            "country_code": "US",
            "telephone_number": "803-296-2942",
            "fax_number": "803-779-9581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUATTLEBAUM",
        "first_name": "LATOVA",
        "middle_name": "NICHELLE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-10",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "21979",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "21979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Staci Jill Quan, M.ED. M.A. LPC
• Alicia Quarles
• Rebecca Michelle Quarles
• Addie Quattlebaum-Hembree, M.ED.
• Jeani Rae Clark Quattlebaum, LMSW
• Patricia Dawes Quattlebaum, M.S.P., CCC-SLP
• Savanah Querze
• Ashleigh Love Quick Ledford, MD
• Brandie Nicole Quick, MS, BCBA
• Sandra K Quick, FNP

• Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.