Provider Demographics
NPI:1801458765
Name:SHOUPE, DANIELLE BUNTON (APRN-FNP)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:BUNTON
Last Name:SHOUPE
Suffix:
Gender:
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DANIELLE
Other - Last Name:BUNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-FNP
Mailing Address - Street 1:8906 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6366
Mailing Address - Country:US
Mailing Address - Phone:803-254-3676
Mailing Address - Fax:803-254-3678
Practice Address - Street 1:830 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3081
Practice Address - Country:US
Practice Address - Phone:843-781-7428
Practice Address - Fax:843-781-7429
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6164Medicaid