Provider Demographics
NPI:1568604338
Name:SMITH, SHANNON BRIGHT (APRN, ACNS-BC, CNE)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:BRIGHT
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, ACNS-BC, CNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MOUNT HOPE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-9013
Mailing Address - Country:US
Mailing Address - Phone:843-437-3790
Mailing Address - Fax:803-535-5576
Practice Address - Street 1:400 MAGNOLIA ST # 135A
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6815
Practice Address - Country:US
Practice Address - Phone:803-535-5241
Practice Address - Fax:803-535-5576
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18774364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health