Individual
SHELLYANN KORNEGAY-BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
132 SUNDEW RD, ELGIN, SC 29045-9826
(803) 931-3879
Mailing address
136 FORUM RD, STE 4 #443, COLUMBIA, SC 29229
(800) 776-4974
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
39814
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203045590
PERMANENT CARD
NC
Enumeration date
05/14/2015
Last updated
02/03/2022
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