Provider Demographics
NPI:1942316823
Name:SHELLY, KAREN R (RNBC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:R
Last Name:SHELLY
Suffix:
Gender:F
Credentials:RNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHADDORK CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7972
Mailing Address - Country:US
Mailing Address - Phone:803-957-4611
Mailing Address - Fax:
Practice Address - Street 1:1409 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-3658
Practice Address - Fax:803-777-0126
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR46983163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health