Individual
SHANNON JOY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, AGPCNP-BC
Contact information
Practice address
255 ENTERPRISE BLVD STE 101, GREENVILLE, SC 29615-3530
(864) 454-8120
(864) 454-8125
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
22971
SC
363LA2200X
Adult Health Nurse Practitioner
Primary
22971
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
11/06/2019
Last updated
10/04/2022
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