Provider Demographics
NPI:1902137821
Name:FULTON, SHANNON RENEE (CRNA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:FULTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 12TH AVE S
Mailing Address - Street 2:SUITE 3108
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4922
Mailing Address - Country:US
Mailing Address - Phone:615-343-6336
Mailing Address - Fax:615-343-1966
Practice Address - Street 1:1215 12TH AVE S
Practice Address - Street 2:SUITE 3108
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4922
Practice Address - Country:US
Practice Address - Phone:615-343-6336
Practice Address - Fax:615-343-1966
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14658367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered