Healthcare Provider Details

I. General information

NPI: 1619415593
Provider Name (Legal Business Name): SHANNON HORTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 CELANESE RD
ROCK HILL SC
29732-1722
US

IV. Provider business mailing address

500 LAKESHORE PKWY
ROCK HILL SC
29730-4273
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-3103
  • Fax: 803-325-2232
Mailing address:
  • Phone: 803-818-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20680
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: