Healthcare Provider Details

I. General information

NPI: 1598897316
Provider Name (Legal Business Name): SHELLEY R KNOX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W MAIN ST ATTN CREDENTIALING
LEXINGTON SC
29072-2507
US

IV. Provider business mailing address

811 W MAIN ST ATTN CREDENTIALING
LEXINGTON SC
29072-2507
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-6100
  • Fax: 803-358-6167
Mailing address:
  • Phone: 803-358-6100
  • Fax: 803-358-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN 1252
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: