Provider Demographics
NPI:1104232917
Name:SEYMOUR, SHELLEY (APRN-BC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 COMMONWEALTH DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4850
Mailing Address - Country:US
Mailing Address - Phone:864-675-4000
Mailing Address - Fax:
Practice Address - Street 1:135 COMMONWEALTH DR STE 250
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4850
Practice Address - Country:US
Practice Address - Phone:864-675-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18912363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care