Individual
MRS. SHANNON MARIA KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 HOSPITAL CENTER BLVD, HILTON HEAD, SC 29926-2738
(843) 681-6122
Mailing address
1601 GREENE ST, COLUMBIA, SC 29208-4001
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
27405
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/24/2022
Last updated
09/12/2023
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