Healthcare Provider Details

I. General information

NPI: 1275509739
Provider Name (Legal Business Name): SHANNON R HUSSEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 HIGHWAY 9 E
LITTLE RIVER SC
29566-7826
US

IV. Provider business mailing address

PO BOX 3439
NORTH MYRTLE BEACH SC
29582-0439
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax: 866-778-9612
Mailing address:
  • Phone: 843-839-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 690504
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: