Basic Information
| Provider Information | |||||||||
| NPI: | 1912988411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOUTEN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | APRN-BC, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 TETON RD | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291544659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034699819 | ||||||||
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| Practice Location | |||||||||
| Address1: | 545 SUMTER HWY | ||||||||
| Address2: | |||||||||
| City: | BISHOPVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290107601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034845317 | ||||||||
| FaxNumber: | 8034844533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 04/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN 213 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | P00906566 | 01 | SC | RAILROAD MEDICARE PTAN | OTHER | FNP002 | 05 | SC | MEDICAID |