Provider Demographics
NPI:1750329694
Name:SHEALY, RUTH S (NP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:S
Last Name:SHEALY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22580 HIGHWAY 76 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-8439
Mailing Address - Country:US
Mailing Address - Phone:864-833-5986
Mailing Address - Fax:864-833-0599
Practice Address - Street 1:22580 HIGHWAY 76 E
Practice Address - Street 2:SUITE 100
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-8439
Practice Address - Country:US
Practice Address - Phone:864-833-5986
Practice Address - Fax:864-833-0599
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC29093363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0617Medicaid
SCNP0617Medicaid
SC8536Medicare PIN