Healthcare Provider Details

I. General information

NPI: 1912988411
Provider Name (Legal Business Name): SUSAN C SCOUTEN APRN-BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 SUMTER HWY
BISHOPVILLE SC
29010-7601
US

IV. Provider business mailing address

13 TETON RD
SUMTER SC
29154-4659
US

V. Phone/Fax

Practice location:
  • Phone: 803-484-5317
  • Fax: 803-484-4533
Mailing address:
  • Phone: 803-469-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 213
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: