Provider Demographics
NPI:1316320344
Name:KELLER, SHANNON STINSON (CNM)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:STINSON
Last Name:KELLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4011 OLD CLINIC BUILDING
Mailing Address - Street 2:CB #7570
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-843-2490
Mailing Address - Fax:
Practice Address - Street 1:4011 OLD CLINIC BUILDING
Practice Address - Street 2:CB #7570
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7570
Practice Address - Country:US
Practice Address - Phone:919-843-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife