Provider Demographics
NPI:1598897316
Name:KNOX, SHELLEY R (NP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:KNOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W MAIN ST
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2507
Mailing Address - Country:US
Mailing Address - Phone:803-358-6100
Mailing Address - Fax:803-358-6167
Practice Address - Street 1:811 W MAIN ST
Practice Address - Street 2:ATTN CREDENTIALING
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2507
Practice Address - Country:US
Practice Address - Phone:803-358-6100
Practice Address - Fax:803-358-6167
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCAPRN 1252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner