Provider Demographics
NPI:1225695851
Name:SHANNON L. SMITH-STEPHENS, DNP, APRN-BC, PLLC
Entity Type:Organization
Organization Name:SHANNON L. SMITH-STEPHENS, DNP, APRN-BC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/SUPPLIER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SMITH-STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN-BC
Authorized Official - Phone:606-286-0440
Mailing Address - Street 1:6902B GRAHN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-8147
Mailing Address - Country:US
Mailing Address - Phone:606-286-0440
Mailing Address - Fax:606-548-5019
Practice Address - Street 1:6902B GRAHN RD
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-8147
Practice Address - Country:US
Practice Address - Phone:606-922-0121
Practice Address - Fax:606-548-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215968003OtherINDIVIDUAL NPI