Provider Demographics
NPI:1801831250
Name:CORE, SHAWN K (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:K
Last Name:CORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:SHAWN
Other - Middle Name:K
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3 E BENJAMIN DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2705
Mailing Address - Country:US
Mailing Address - Phone:304-455-8082
Mailing Address - Fax:304-455-8165
Practice Address - Street 1:3 E BENJAMIN DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2705
Practice Address - Country:US
Practice Address - Phone:304-455-8082
Practice Address - Fax:304-455-8165
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV51879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2327833Medicaid
WV7105137000Medicaid
OH2327833Medicaid
WV7105137000Medicaid