Provider Demographics
NPI:1164123725
Name:KLEINSCHMIDT, SHANNON DAWN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DAWN
Last Name:KLEINSCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE ST STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2518
Mailing Address - Country:US
Mailing Address - Phone:615-345-6903
Mailing Address - Fax:615-345-6905
Practice Address - Street 1:9321 W THOMAS RD STE 405
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3399
Practice Address - Country:US
Practice Address - Phone:623-236-8507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ285525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily