Provider Demographics
NPI:1104837491
Name:BLACK, SHAWNYA YORK (MSN, APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNYA
Middle Name:YORK
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 VICWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5831
Mailing Address - Country:US
Mailing Address - Phone:931-454-6134
Mailing Address - Fax:
Practice Address - Street 1:225 VON KARMON ROAD
Practice Address - Street 2:
Practice Address - City:ARNOLD AIR FORCE BASE
Practice Address - State:TN
Practice Address - Zip Code:37389-2402
Practice Address - Country:US
Practice Address - Phone:931-454-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000098777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily