Provider Demographics
NPI:1063068567
Name:KLUN, SHANNA KAY (RN, BSN, NP-C)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:KAY
Last Name:KLUN
Suffix:
Gender:F
Credentials:RN, BSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-4481
Mailing Address - Fax:844-658-7526
Practice Address - Street 1:1206 N 1000 W STE B
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5294
Practice Address - Country:US
Practice Address - Phone:812-847-3381
Practice Address - Fax:812-847-9496
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28215527A163WE0003X
IN71009666A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency