=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245800887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHENIKA MITCHELL CARTER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2021
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 WREN ST
-----------------------------------------------------
City | BARNWELL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29812-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-259-3399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 CHESTER ST
-----------------------------------------------------
City | WILLISTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29853-6640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-259-3399
-----------------------------------------------------
Fax | 803-259-4477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 25053
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 64380
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------