Provider Demographics
NPI:1689145591
Name:WILLIAMS, SHANNA M (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47390-1422
Mailing Address - Country:US
Mailing Address - Phone:937-467-3986
Mailing Address - Fax:
Practice Address - Street 1:2302 CHESTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1221
Practice Address - Country:US
Practice Address - Phone:765-488-0345
Practice Address - Fax:765-488-2467
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005816RX363A00000X
IN10002597A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant