Provider Demographics
NPI:1821704628
Name:FYFFE, SHANNON D (APRN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:FYFFE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 HIGHWAY 469
Mailing Address - Street 2:
Mailing Address - City:MARTHA
Mailing Address - State:KY
Mailing Address - Zip Code:41159-9023
Mailing Address - Country:US
Mailing Address - Phone:606-471-4342
Mailing Address - Fax:
Practice Address - Street 1:147 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-7748
Practice Address - Country:US
Practice Address - Phone:502-262-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018611363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health