Provider Demographics
NPI:1417766767
Name:PHILPOT, SHANNON (TCM)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PHILPOT
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MASTER ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2502
Mailing Address - Country:US
Mailing Address - Phone:606-280-4000
Mailing Address - Fax:833-222-3797
Practice Address - Street 1:1200 MASTER ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2502
Practice Address - Country:US
Practice Address - Phone:606-280-4000
Practice Address - Fax:833-222-3797
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP98113750251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management