Liston Alexander Weatherly Jr., APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

21363 Issued in SC

Practice address

1268 S 4TH St
Hartsville, SC 29550-0703

Phone

(803) 484-5317

NPI assigned

Dec 15, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Caresouth Carolina Inc.Group PAC ID 1052221314, 66 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pruitthealth Home Health-Florence Home health agency, Florence, SC, CCN 427129
• McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051
• Carolina Pines Regional Medical Center Hospital, Hartsville, SC, CCN 420010

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: liston.weatherly@csci.eclinicaldirectplus.com

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.

• Caresouth Carolina, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartsville, SC
  • NPI 1720082571
  Medicare reassignment Care Compare group NPD
• Caresouth Carolina, Inc

  • Federally Qualified Health Center (FQHC)
  • Bishopville, SC
  • NPI 1942247846
  NPD
• Caresouth Carolina, Inc

  • Federally Qualified Health Center (FQHC)
  • Society Hill, SC
  • NPI 1194763714
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hartsville, LLC

  • General Acute Care Hospital
  • Hartsville, SC
  • NPI 1174500458
  Care Compare affiliation
• McLeod Regional Medical Center of the Pee Dee, Inc.

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1699756221
  Care Compare affiliation
• Pruitthealth Home Health, Inc.

  • Home Health Agency
  • Florence, SC
  • NPI 1396169611
  Care Compare affiliation
• Pruitthealth Home Health, Inc.

  • Home Health Agency
  • Myrtle Beach, SC
  • NPI 1891225900
  Care Compare affiliation

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

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1912413832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511090",
            "telephone_number": "843-857-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1268 S 4TH ST",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295500703",
            "telephone_number": "803-484-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERLY",
        "first_name": "LISTON",
        "middle_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-15",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "21363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Joan Wallace, FNP-C
• Shalondrice Ward
• Mary Elizabeth Watkins
• We Care of South Carolina LLC
• We the Forerunners
• Amanda Jo Webb, PA-C
• Angela Wellman
• Wellness Boutique LLC
• Jesse Michael West, PH.D
• Harold Neil Wheeler, M.D.

• Nurse Practitioner in Hartsville, SC
• Providers in Hartsville, 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 Sep 22, 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.