Healthcare Provider Details

I. General information

NPI: 1326587387
Provider Name (Legal Business Name): SHANKANA JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S JONES RD
OLANTA SC
29114-9705
US

IV. Provider business mailing address

8906 TWO NOTCH RD
COLUMBIA SC
29223-6366
US

V. Phone/Fax

Practice location:
  • Phone: 843-396-9730
  • Fax: 843-396-9735
Mailing address:
  • Phone: 803-254-3676
  • Fax: 803-254-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number218052
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25512
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: