Provider Demographics
NPI:1053103721
Name:DART, SHANNON NICOLE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NICOLE
Last Name:DART
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-9006
Mailing Address - Country:US
Mailing Address - Phone:252-619-4629
Mailing Address - Fax:
Practice Address - Street 1:108 JORDAN LN
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NC
Practice Address - Zip Code:27921-9006
Practice Address - Country:US
Practice Address - Phone:252-619-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189029163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice