Provider Demographics
NPI:1134118136
Name:SHENTON, LINDA S (ACNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:SHENTON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 RIVERCHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1777
Mailing Address - Country:US
Mailing Address - Phone:803-329-2636
Mailing Address - Fax:803-329-2184
Practice Address - Street 1:1436 RIVERCHASE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1777
Practice Address - Country:US
Practice Address - Phone:803-329-2636
Practice Address - Fax:803-329-2184
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1015363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPO186Medicaid
SCP00126915OtherSCBCBS
SCNPO186Medicaid
SCP00126915OtherSCBCBS