Provider Demographics
NPI:1013963677
Name:SHUMPERT, EVELYNNE DIANE (RNC, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:EVELYNNE
Middle Name:DIANE
Last Name:SHUMPERT
Suffix:
Gender:F
Credentials:RNC, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:5900 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1301
Practice Address - Country:US
Practice Address - Phone:803-695-5450
Practice Address - Fax:803-695-5469
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0366Medicaid
SCAA51325775Medicare PIN
SCAA5132F935Medicare PIN