Provider Demographics
NPI:1669533550
Name:HEARD, SHANNON M (NP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:HEARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 BRE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-2944
Mailing Address - Country:US
Mailing Address - Phone:931-363-3086
Mailing Address - Fax:931-363-7928
Practice Address - Street 1:181 BRE AVE STE C
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-2944
Practice Address - Country:US
Practice Address - Phone:931-363-3086
Practice Address - Fax:931-363-7928
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12056363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725122Medicaid
TN3642760Medicaid
TN4125016OtherBCBS TN
TN3725122Medicaid
TNP00326633Medicare PIN
TNDB8051Medicare PIN
TN4125016OtherBCBS TN
Q65364Medicare UPIN