Provider Demographics
NPI:1073258851
Name:SWEATT, SHAVONNE (AGNP-C, AGNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:
Last Name:SWEATT
Suffix:
Gender:F
Credentials:AGNP-C, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 HANSEL LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-9805
Mailing Address - Country:US
Mailing Address - Phone:703-987-8865
Mailing Address - Fax:
Practice Address - Street 1:2910 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4199
Practice Address - Country:US
Practice Address - Phone:281-479-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187533363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health