Provider Demographics
NPI:1326581448
Name:WILLIAMS, SHANNON RENE (AG-ACNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4400 BROADWAY STE 520
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-960-7600
Practice Address - Fax:816-960-7699
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016039316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner