Provider Demographics
NPI:1104462894
Name:YOKUM, SHAUNNA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHAUNNA
Middle Name:MARIE
Last Name:YOKUM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GASTON MANOR RD
Mailing Address - Street 2:
Mailing Address - City:JANE LEW
Mailing Address - State:WV
Mailing Address - Zip Code:26378-8027
Mailing Address - Country:US
Mailing Address - Phone:304-940-9451
Mailing Address - Fax:
Practice Address - Street 1:921 MINERAL RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1342
Practice Address - Country:US
Practice Address - Phone:304-462-1020
Practice Address - Fax:304-462-1021
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily