Provider Demographics
NPI:1215415534
Name:SHANAHAN, MERI MELODIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MERI
Middle Name:MELODIE
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MERI
Other - Middle Name:MELODIE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:254 REN MAR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-3723
Mailing Address - Country:US
Mailing Address - Phone:615-746-0203
Mailing Address - Fax:615-746-0001
Practice Address - Street 1:254 REN MAR DR.
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146
Practice Address - Country:US
Practice Address - Phone:615-746-0203
Practice Address - Fax:615-746-0001
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31684364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health