Provider Demographics
NPI:1427742774
Name:HARRELL, SHANNON L (NP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:L
Last Name:HARRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 HAMMER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-3090
Mailing Address - Country:US
Mailing Address - Phone:229-560-8758
Mailing Address - Fax:
Practice Address - Street 1:4893 HAMMER LN
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-3090
Practice Address - Country:US
Practice Address - Phone:229-560-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN281854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily