Provider Demographics
NPI:1942830781
Name:LEWIS, SHANNON (DNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5788 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-2217
Mailing Address - Country:US
Mailing Address - Phone:251-604-9510
Mailing Address - Fax:
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-2099
Practice Address - Fax:251-435-6311
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-071591363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health