Provider Demographics
NPI:1235525809
Name:SHIRLEY, SHANNON RENEE (MSN, RN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RENEE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:RENEE
Other - Last Name:STEENBERGEN (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1495 S DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1457
Mailing Address - Country:US
Mailing Address - Phone:270-786-2372
Mailing Address - Fax:270-786-2472
Practice Address - Street 1:1501 S DIXIE ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1480
Practice Address - Country:US
Practice Address - Phone:270-786-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily