Provider Demographics
NPI:1407199011
Name:CATOE, SHERESA BLACKMON (DNP)
Entity Type:Individual
Prefix:MRS
First Name:SHERESA
Middle Name:BLACKMON
Last Name:CATOE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:SHERESA
Other - Middle Name:BLACKMON
Other - Last Name:MCKITTRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:505 WOODLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-1704
Mailing Address - Country:US
Mailing Address - Phone:803-283-7465
Mailing Address - Fax:877-299-9396
Practice Address - Street 1:505 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1704
Practice Address - Country:US
Practice Address - Phone:803-313-3700
Practice Address - Fax:803-289-0909
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18183363LA2100X
SCSC18183363LF0000X, 363LP0808X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2429Medicaid