Provider Demographics
NPI:1538811997
Name:EDWARDS, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TABLE ROCK
Mailing Address - State:NE
Mailing Address - Zip Code:68447-3021
Mailing Address - Country:US
Mailing Address - Phone:816-654-5138
Mailing Address - Fax:
Practice Address - Street 1:308 LUZERNE
Practice Address - Street 2:
Practice Address - City:TABLE ROCK
Practice Address - State:NE
Practice Address - Zip Code:68447
Practice Address - Country:US
Practice Address - Phone:816-654-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X, 372600000X, 3747P1801X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant