Provider Demographics
NPI:1598591075
Name:DAVE, SHANNA STIVERS (APRN-CNP PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:STIVERS
Last Name:DAVE
Suffix:
Gender:F
Credentials:APRN-CNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:EMINENCE
Mailing Address - State:KY
Mailing Address - Zip Code:40019-0124
Mailing Address - Country:US
Mailing Address - Phone:502-593-0083
Mailing Address - Fax:502-255-0600
Practice Address - Street 1:18 ALEXANDER AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:KY
Practice Address - Zip Code:40006-1114
Practice Address - Country:US
Practice Address - Phone:502-255-0222
Practice Address - Fax:502-255-0600
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4027554363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health