Provider Demographics
NPI:1275895948
Name:KARTCHNER, SHANNON (RN)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:KARTCHNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 S 5600 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-1249
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:801-584-1276
Practice Address - Street 1:2750 S 5600 W
Practice Address - Street 2:SUITE B
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1249
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-1276
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT279336-3102163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care