Provider Demographics
NPI:1699515809
Name:SHEALY, LARRY TYLER (DNP MSN APRN)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:TYLER
Last Name:SHEALY
Suffix:
Gender:M
Credentials:DNP MSN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 WADE WAY
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-4124
Mailing Address - Country:US
Mailing Address - Phone:803-645-4339
Mailing Address - Fax:
Practice Address - Street 1:626 WADE WAY
Practice Address - Street 2:
Practice Address - City:GRANITEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29829-4124
Practice Address - Country:US
Practice Address - Phone:803-645-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN266557163W00000X
SC269039163W00000X
SC29158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse