Provider Demographics
NPI:1760478721
Name:COLE, SHANNON ELIZABETH (DNP,APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:COLE
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Gender:F
Credentials:DNP,APRN,BC
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Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:102 W 18TH STREET
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0990
Mailing Address - Country:US
Mailing Address - Phone:270-466-9300
Mailing Address - Fax:270-466-3300
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:KY
Practice Address - Zip Code:42286-0317
Practice Address - Country:US
Practice Address - Phone:270-466-9300
Practice Address - Fax:270-466-3300
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3325P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQ03081Medicare UPIN
KY0784902Medicare PIN