Provider Demographics
NPI:1518991058
Name:SHANNON BRACKETT HINKLE, PA-C, PLLC
Entity Type:Organization
Organization Name:SHANNON BRACKETT HINKLE, PA-C, PLLC
Other - Org Name:SHANNON BRACKETT HINKLE, PA-C, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:BRACKETT
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:252-442-7462
Mailing Address - Street 1:6411 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-8925
Mailing Address - Country:US
Mailing Address - Phone:252-442-7462
Mailing Address - Fax:252-446-7463
Practice Address - Street 1:6411 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-8925
Practice Address - Country:US
Practice Address - Phone:252-442-7462
Practice Address - Fax:252-446-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3510363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty