Provider Demographics
NPI:1265858047
Name:COWARD, SHANNON HIATT (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:HIATT
Last Name:COWARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:HIATT
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:101 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7639
Mailing Address - Country:US
Mailing Address - Phone:919-563-2500
Mailing Address - Fax:919-563-3535
Practice Address - Street 1:101 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7639
Practice Address - Country:US
Practice Address - Phone:919-563-2500
Practice Address - Fax:919-563-3535
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006784363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology