Provider Demographics
NPI:1598320145
Name:MANN, SHAWNA (APRN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:MANN
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 1:1720 NICHOLASVILLE RD STE 702
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1489
Mailing Address - Country:US
Mailing Address - Phone:859-264-8811
Mailing Address - Fax:859-264-8822
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 702
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1489
Practice Address - Country:US
Practice Address - Phone:859-264-8811
Practice Address - Fax:859-264-8822
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1123073363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner