Provider Demographics
NPI:1689969982
Name:BLEVINS, SHANNON DIANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:DIANE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2606 GREENWAY DR BLDG SUITE101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1904
Mailing Address - Country:US
Mailing Address - Phone:865-687-3313
Mailing Address - Fax:865-687-3362
Practice Address - Street 1:2606 GREENWAY DR BLDG SUITE101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1904
Practice Address - Country:US
Practice Address - Phone:865-687-3313
Practice Address - Fax:865-687-3362
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily