Individual provider Active NPI

Courtney Sheppard, NP

  • Family Nurse Practitioner
  • Anderson, SC
National Provider Identifier
1154047447
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26555 Issued in SC
Practice address
1510 N Fant St
Anderson, SC 29621-4708
Phone
(864) 226-1219
NPI assigned
Oct 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26555 SC Primary

Addresses

Primary practice location

1510 N Fant St
Anderson, SC 29621-4708

Mailing address

1510 N Fant St
Anderson, SC 29621-4708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240222000159 SC Practitioner - Nurse Practitioner 2668816299 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment
Group practices
Pruitthealth Hospice IncGroup PAC ID 2264344217, 42 clinicians

Practice addresses (Care Compare)

1510 N Fant St
Anderson, SC 29621-4708
Phone (864) 226-1219

Hospital & facility affiliations

  • Pruitthealth Home Health-Columbia Home health agency, Columbia, SC, CCN 427130
  • Anmed Health Hospital, Anderson, SC, CCN 420027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2655SCMDEndodontist
26555SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pruitthealth Hospice, Inc. CurrentSince Jan 10, 2024 Accepting new patients
Pruitthealth Hospice, Inc. CurrentSince Jan 10, 2024 Accepting new patients

Locations

1626 Jeurgens Ct
Norcross, GA 30093
Phone (770) 806-6875

1510 N Fant St
Anderson, SC 29621
Phone (864) 226-1219

2051 Elijah Ludd Rd
Ste 1
Florence, SC 29501
Phone (843) 573-8623

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1154047447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 N FANT ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296214708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 N FANT ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296214708",
            "telephone_number": "864-226-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPPARD",
        "first_name": "COURTNEY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-10-18",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "26555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

Verify at the official NPI Registry.