Provider Demographics
NPI:1912988411
Name:SCOUTEN, SUSAN C (APRN-BC, FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:SCOUTEN
Suffix:
Gender:F
Credentials:APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TETON RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-4659
Mailing Address - Country:US
Mailing Address - Phone:803-469-9819
Mailing Address - Fax:
Practice Address - Street 1:545 SUMTER HWY
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-7601
Practice Address - Country:US
Practice Address - Phone:803-484-5317
Practice Address - Fax:803-484-4533
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN 213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00906566OtherRAILROAD MEDICARE PTAN
SCFNP002Medicaid
SCP00906566OtherRAILROAD MEDICARE PTAN
SCS66155Medicare UPIN