Provider Demographics
NPI:1922128198
Name:RANKIN, SHUVON BLACKWELL (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHUVON
Middle Name:BLACKWELL
Last Name:RANKIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 VONLYN DRIVE
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320
Mailing Address - Country:US
Mailing Address - Phone:336-215-8866
Mailing Address - Fax:
Practice Address - Street 1:1818 RICHARDSON DR STE A
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5450
Practice Address - Country:US
Practice Address - Phone:336-349-5040
Practice Address - Fax:336-369-5366
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006408363LF0000X
NC168582163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse