Provider Demographics
NPI:1912603846
Name:PORTIS, SHANNON (DNP, WHNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PORTIS
Suffix:
Gender:F
Credentials:DNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 23RD AVE N STE 250
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6514
Mailing Address - Country:US
Mailing Address - Phone:615-342-6880
Mailing Address - Fax:
Practice Address - Street 1:330 23RD AVE N STE 250
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6514
Practice Address - Country:US
Practice Address - Phone:615-342-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN205061163WX0002X
TN36163363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk