Provider Demographics
NPI:1710362827
Name:SHEALY, ASHTON (MSN, RN, CPNP)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:SHEALY
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
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 3788
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3788
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:803-753-5591
Practice Address - Street 1:120 W CHURCH ST
Practice Address - Street 2:STE.E
Practice Address - City:BATESBURG-LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29006-2107
Practice Address - Country:US
Practice Address - Phone:803-532-2208
Practice Address - Fax:803-604-0207
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19618363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics