1801458765 NPI number — MISS DANIELLE BUNTON SHOUPE APRN-FNP

Table of content: MISS DANIELLE BUNTON SHOUPE APRN-FNP (NPI 1801458765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801458765 NPI number — MISS DANIELLE BUNTON SHOUPE APRN-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOUPE
Provider First Name:
DANIELLE
Provider Middle Name:
BUNTON
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
APRN-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUNTON
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN-FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801458765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8906 TWO NOTCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29223-6366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-254-3676
Provider Business Mailing Address Fax Number:
803-254-3678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
457 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTERBORO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29488-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-781-7428
Provider Business Practice Location Address Fax Number:
843-781-7429
Provider Enumeration Date:
07/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  22978 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP6164 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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