Provider Demographics
NPI:1922497239
Name:COPE, SHANNON H (NP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:H
Last Name:COPE
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:1120 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4656
Practice Address - Country:US
Practice Address - Phone:864-455-8897
Practice Address - Fax:864-455-8555
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28177713A163W00000X
SC85341163W00000X
IN71005693A363LW0102X
SC20462363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201316620Medicaid
SCNP4194Medicaid
SCPENDINGMedicare PIN