SHANNON JACKSON GOODING MSN FNP-C NPI 1134570336

NPI Information

NPI: 1134570336
Provider Name: SHANNON JACKSON GOODING, MSN, FNP-C
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

PECOS Registration: Yes

Address:
3710 LANDMARK DR STE 300
COLUMBIA, SC
ZIP 29204
Phone: (803) 898-1470
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Shannon Jackson Gooding, MSN, FNP-C is a pediatrics nurse practitioner in Columbia, SC. Shannon Jackson Gooding, MSN, FNP-C NPI is 1134570336. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3710 LANDMARK DR STE 300
COLUMBIA, SC
ZIP 29204
Phone: (803) 898-1470

The NPI 1134570336 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/29/2016 and was last updated on 9/24/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363L00000X	Nurse Practitioner		5010159	NORTH CAROLINA	No
2	363LP0200X	Nurse Practitioner	Pediatrics	20509	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	1134570336	MEDICAID	NORTH CAROLINA
2	1134570336	MEDICAID	SOUTH CAROLINA
3	NP4540	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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