Provider Demographics
NPI:1861812711
Name:BROWN, SHANNEN (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SHANNEN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 NEW SHEPHERDSVILLE RD
Mailing Address - Street 2:SCN OFFICE BUILDING B, SUITE 110
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-8040
Mailing Address - Country:US
Mailing Address - Phone:502-350-5367
Mailing Address - Fax:502-350-5376
Practice Address - Street 1:4371 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:SCN OFFICE BUILDING B, SUITE 110
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8040
Practice Address - Country:US
Practice Address - Phone:502-350-5367
Practice Address - Fax:502-350-5376
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT11052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer