Shanna H Mack, NP

Primary specialty

Occupational Health Nurse PractitionerTaxonomy code 363LX0106X

License

2144 Issued in SC

Practice address

3799 12TH Street Ext Ste 1110
Cayce, SC 29033-3750

Phone

(803) 755-3337

Fax

(803) 955-2225

NPI assigned

May 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Shanna Leigh Hutto Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Lexington County Health Services District Inc

  dba Lexington Medical Center

  • General Acute Care Hospital
  • West Columbia, SC
  • NPI 1356366314
  NPD

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1699983338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6069",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291716069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3799 12TH STREET EXT STE 1110",
            "city": "CAYCE",
            "state": "SC",
            "postal_code": "290333750",
            "telephone_number": "803-755-3337",
            "fax_number": "803-955-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "SHANNA",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "SC",
            "license": "2144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "84231",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smack12275@direct.lexmed.com",
            "affiliation": "N",
            "address_1": "3799 12th Street Ext Ste 1110",
            "city": "Cayce",
            "state": "SC",
            "country_code": "US",
            "postal_code": "290333750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNA",
            "last_name": "HUTTO",
            "middle_name": "LEIGH",
            "prefix": "MS.",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Emmett Lowry, DC
• Hadiyah Lucien
• Scarlett Luther
• Erin Pierce Lynn
• Matilda Macarthur
• Jonathan Made, PHARMD
• Richard Anthony Mann Jr., FNP-BC
• Eva Maron, LISW-CP
• Henry Martin Jr., MD
• Whitney Mathias, LMSW

• Occupational Health Nurse Practitioner in Cayce, SC
• Providers in Cayce, SC by specialty
• Occupational Health Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.