Provider Demographics
NPI:1578782041
Name:TROUSE, SHANNON A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:A
Last Name:TROUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1728
Mailing Address - Country:US
Mailing Address - Phone:706-507-1000
Mailing Address - Fax:706-507-1006
Practice Address - Street 1:8160 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1728
Practice Address - Country:US
Practice Address - Phone:706-507-1000
Practice Address - Fax:706-507-1006
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA509122505AMedicaid