Healthcare Provider Details

I. General information

NPI: 1699257196
Provider Name (Legal Business Name): JANETTE TEMPLETON SHELLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANETTE SUZANNE STREET

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 SPRINGDALE DR
CLINTON SC
29325-7266
US

IV. Provider business mailing address

2858 SUNSET BLVD
WEST COLUMBIA SC
29169-3420
US

V. Phone/Fax

Practice location:
  • Phone: 910-742-9243
  • Fax: 888-746-1787
Mailing address:
  • Phone: 803-699-9073
  • Fax: 866-527-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22217
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number22217
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: