Provider Demographics
NPI:1427723022
Name:PROST, SHANNON ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:PROST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-9799
Mailing Address - Country:US
Mailing Address - Phone:740-942-8638
Mailing Address - Fax:740-942-9052
Practice Address - Street 1:951 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-9799
Practice Address - Country:US
Practice Address - Phone:740-942-8638
Practice Address - Fax:740-942-9052
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OH50.007308RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant