Provider Demographics
NPI:1386693414
Name:PHIPPS, SHANNON L (DO)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:P
Other - Last Name:DRAMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8650
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:10121 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3500
Practice Address - Country:US
Practice Address - Phone:509-783-4949
Practice Address - Fax:509-783-6827
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9576207Q00000X
WAOP60036526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8878702OtherMEDICARE PTAN
WAG8878702OtherMEDICARE PTAN