Healthcare Provider Details

I. General information

NPI: 1083479117
Provider Name (Legal Business Name): SHAMEKA DENISE CARTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 ELECTRIC DR
SUMTER SC
29153-1933
US

IV. Provider business mailing address

755 ELECTRIC DR
SUMTER SC
29153-1933
US

V. Phone/Fax

Practice location:
  • Phone: 803-905-5100
  • Fax: 803-905-5170
Mailing address:
  • Phone: 803-905-5100
  • Fax: 803-905-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29512
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: