Healthcare Provider Details

I. General information

NPI: 1932052107
Provider Name (Legal Business Name): SHELLY WHITAKER WALTERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CLEMSON BLVD STE 1
ANDERSON SC
29621-1328
US

IV. Provider business mailing address

102 ROXBURY CT
ANDERSON SC
29625-2509
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-3452
  • Fax: 864-512-3453
Mailing address:
  • Phone: 864-940-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number32400
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: