Provider Demographics
NPI:1922683085
Name:LYNCH, SHANNON LEE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 DOWNS CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5117
Mailing Address - Country:US
Mailing Address - Phone:919-222-7295
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL DR STE 250
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2390
Practice Address - Country:US
Practice Address - Phone:318-746-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily