Provider Demographics
NPI:1184221541
Name:WILLIAMS, SHANNON LEE (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JEFFERSON PARK PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4592
Mailing Address - Country:US
Mailing Address - Phone:502-797-4004
Mailing Address - Fax:
Practice Address - Street 1:5807 HARRODS GLEN DR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7650
Practice Address - Country:US
Practice Address - Phone:502-410-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015279363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health