Provider Demographics
NPI:1386675569
Name:LINGINFELTER, SHANNON R (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:LINGINFELTER
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Mailing Address - Street 2:616 SMITHVIEW DRIVE
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-6100
Mailing Address - Country:US
Mailing Address - Phone:865-379-2277
Mailing Address - Fax:865-738-0087
Practice Address - Street 1:CEDAR CREEK PEDIATRIC & ADOLESCENT MEDICINE, PC
Practice Address - Street 2:616 SMITHVIEW DRIVE
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6100
Practice Address - Country:US
Practice Address - Phone:865-379-2277
Practice Address - Fax:865-738-0087
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN 0000129005OtherRN LICENSE
TNTN103OtherJOHN DEERE ID NUMBER
TN2678OtherCERTIFICATE OF FITNESS
TN2678OtherCERTIFICATE OF FITNESS