Provider Demographics
NPI:1225562978
Name:CASEY, SHANNON DENISE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:DENISE
Last Name:CASEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 US HIGHWAY 231 N
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-9233
Mailing Address - Country:US
Mailing Address - Phone:270-256-0056
Mailing Address - Fax:
Practice Address - Street 1:20 E MCMURTRY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1647
Practice Address - Country:US
Practice Address - Phone:270-504-1300
Practice Address - Fax:270-504-1380
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011196363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3011196OtherLICENSE