Provider Demographics
NPI:1669645784
Name:DAVIS, SHANNON NOELLE LAWLEY (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NOELLE LAWLEY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2238
Mailing Address - Country:US
Mailing Address - Phone:251-471-7971
Mailing Address - Fax:251-471-7334
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7971
Practice Address - Fax:251-471-7334
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-100053363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51594120OtherBCBS - 2451 FILLINGIM
AL51594124OtherBCBS - 575 STANTON RD
MS05022892Medicaid
MS05022892Medicaid