Provider Demographics
NPI:1588614283
Name:PRESSLEY, SHANNA YVONNE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:YVONNE
Last Name:PRESSLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:SHANNA
Other - Middle Name:YVONNE
Other - Last Name:HARVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2000 BROOKSIDE DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4627
Mailing Address - Country:US
Mailing Address - Phone:423-857-5905
Mailing Address - Fax:423-857-5904
Practice Address - Street 1:2000 BROOKSIDE DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4627
Practice Address - Country:US
Practice Address - Phone:423-857-5905
Practice Address - Fax:423-857-5904
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA877363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588614283Medicaid
TN3669173Medicaid
NC1588614283Medicaid
TNP01706815OtherRAILROAD MEDICARE
P01509Medicare UPIN
VA1588614283Medicaid