Provider Demographics
NPI:1699837104
Name:SHUNNARAH, KATHRYN B (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:B
Last Name:SHUNNARAH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534595
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4595
Mailing Address - Country:US
Mailing Address - Phone:321-636-2111
Mailing Address - Fax:321-636-7180
Practice Address - Street 1:107 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:321-636-2111
Practice Address - Fax:321-636-7180
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4224S363L00000X
FLARNP9387289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9387289OtherARNP LICENSE
KY4224SOtherKY LICENSE