Individual
SHANNON J GOODING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-C
Contact information
Practice address
3710 LANDMARK DR STE 300, COLUMBIA, SC 29204
(803) 898-1470
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5010159
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
20509
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134570336
—
NC
05
—
1134570336
—
SC
05
—
NP4540
—
SC
Enumeration date
06/29/2016
Last updated
06/11/2024
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