Provider Demographics
NPI:1972856706
Name:ORMSBEE, SHANNON TARA (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:TARA
Last Name:ORMSBEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:TARA
Other - Last Name:WHITTEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:209 TIMBERLAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:802-779-7128
Mailing Address - Fax:910-908-7738
Practice Address - Street 1:WAMC CLARK HEALTH CLINIC
Practice Address - Street 2:BLDG 5-4257 BASTOGNE STREET
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-2575
Practice Address - Fax:910-908-7738
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005158363LF0000X
NC5009248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily