Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ian Shaver

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1356041065

Ian Shaver is a Nurse Practitioner in Clinton, South Carolina. Qualified in 2022, 4 years ago. Practices with Lifesource of North Carolina, a 170-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in North Carolina and South Carolina.

Years since qualifying
4
Licensed in
NC, SC
In the registry since
2023
Specialties on file
2

Practice location Address checks out

939 Springdale Dr
Clinton, SC 29325-7266
Phone: (910) 742-9243
Fax: (888) 746-1787
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1086 Secessionville Rd, Charleston, SC 29412-9744 — (704) 681-2417

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 27278 (SC)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 321428 (NC)

Record details

NPI number1356041065
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 9, 2023
Last updated in NPPESMay 22, 2023
Certification dateMay 22, 2023
Mailing address1086 Secessionville Rd, Charleston, SC 29412-9744

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Lifesource Of North Carolina — 170 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Clinton