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General NPI Number Information
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NPI Number | 1023496627
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Entity Type | Individual
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Provider Name | SHELLYANN KORNEGAY-BROOKS LPN
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Gender | Female
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 132 SUNDEW RD
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City | ELGIN
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State | SC
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Zip | 29045-9826
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Country | US
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Telephone | 803-931-3879
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Fax |
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Provider Business Mailing Address
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Address Line | 136 FORUM RD STE 4 #443
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 800-776-4974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 39814
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License Number State | SC
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