Individual provider · NPI-1
Carlton Brooks Shealy III, RN
Registered Nurse · Aiken, SC
NPI number1316768112
StatusActive
Last updated in NPPESOct 23, 2024
Details
- NPI
- 1316768112
- Entity type
- Individual (NPI-1)
- Name
- Mr. Carlton Brooks Shealy III
- Credential
- RN
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 23, 2024
- Certification date
- Oct 21, 2024
- Last updated
- Oct 23, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163W00000X | Registered Nurse | 237093 | SC | Yes |
| 163WC0400X | Registered Nurse, Case Management | 237093 | SC | |
| 163WH0200X | Registered Nurse, Home Health | 237093 | SC |
Practice location
420 Pavilion PassAiken, SC 29803
Phone 803-257-0894
Mailing address
725 Riding Ridge CtAiken, SC 29801-0686
Phone 803-257-0894
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