Provider Demographics
NPI:1710122353
Name:WILLIAMS, SHANNON ANGEL (BA; ASN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANGEL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BA; ASN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ANGEL
Other - Last Name:BAILEY-CHARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA; ASN
Mailing Address - Street 1:DEPT 888182
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-0001
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:815 W 5TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3810
Practice Address - Country:US
Practice Address - Phone:423-586-5032
Practice Address - Fax:423-581-8473
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN167805163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health