Provider Demographics
NPI:1457828428
Name:WASHINGTON, SHENIKA N (APRN)
Entity Type:Individual
Prefix:
First Name:SHENIKA
Middle Name:N
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SOMERSET CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7540
Mailing Address - Country:US
Mailing Address - Phone:601-506-1162
Mailing Address - Fax:
Practice Address - Street 1:501 AVALON WAY STE C
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7500
Practice Address - Country:US
Practice Address - Phone:601-992-9790
Practice Address - Fax:601-992-9796
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903032363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily