Provider Demographics
NPI:1972053627
Name:BURKHART, SHANNON (FNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BURKHART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1700
Mailing Address - Country:US
Mailing Address - Phone:937-746-8357
Mailing Address - Fax:937-746-1992
Practice Address - Street 1:909 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1700
Practice Address - Country:US
Practice Address - Phone:937-746-8357
Practice Address - Fax:937-746-1992
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0191655Medicaid