Provider Demographics
NPI:1093773475
Name:BATTLESON, CONNIE SUE (RN, MSN, C-FNP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:SUE
Last Name:BATTLESON
Suffix:
Gender:F
Credentials:RN, MSN, C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:8311 WARREN H ABERNATHY HWY
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1249
Practice Address - Country:US
Practice Address - Phone:864-560-9696
Practice Address - Fax:864-562-5230
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0351Medicaid
SCS937006067Medicare PIN
SCS937003365Medicare PIN
SCNP0351Medicaid
SCSC15166067Medicare PIN
SC500006500Medicare PIN
SCS93700Medicare UPIN