Provider Demographics
NPI:1902950850
Name:ATCHISON, SHANNON REBECCA (FNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:REBECCA
Last Name:ATCHISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 92
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-1256
Mailing Address - Country:US
Mailing Address - Phone:731-836-9444
Mailing Address - Fax:731-836-9443
Practice Address - Street 1:115 W TIGRETT ST
Practice Address - Street 2:APT A
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-1256
Practice Address - Country:US
Practice Address - Phone:731-836-9444
Practice Address - Fax:731-836-9443
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524536Medicaid
4304484OtherBCBS
TNAPN0000011667OtherSTATE LICENSE
TNAPN0000011667OtherSTATE LICENSE
TN103I509977Medicare PIN