Provider Demographics
NPI:1356932412
Name:SHUMPERT, MARY AMANDA CAMPBELL (NP)
Entity type:Individual
Prefix:
First Name:MARY AMANDA
Middle Name:CAMPBELL
Last Name:SHUMPERT
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 1:101 WILLIAM H JOHNSON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2769
Mailing Address - Country:US
Mailing Address - Phone:843-777-7400
Mailing Address - Fax:
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 500
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2769
Practice Address - Country:US
Practice Address - Phone:843-777-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily