Provider Demographics
NPI:1013184266
Name:MEYERS, SHANNA M (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:M
Last Name:MEYERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:A
Other - Last Name:MCCAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:800 ROSE STREET UKMC ROOM C225
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-6602
Mailing Address - Fax:859-323-6840
Practice Address - Street 1:800 ROSE STREET UKMC
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1200
Practice Address - Country:US
Practice Address - Phone:859-323-6602
Practice Address - Fax:859-323-6840
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005617363LA2100X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100061270Medicaid
KY3005617OtherLICENSE