Provider Demographics
NPI:1184600793
Name:SHAUGHNESSY-GRANGER, KIM PATRICIA (DNP, CNM)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:PATRICIA
Last Name:SHAUGHNESSY-GRANGER
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:PATRICIA
Other - Last Name:LAVELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3259 CATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-5109
Mailing Address - Country:US
Mailing Address - Phone:703-784-1500
Mailing Address - Fax:
Practice Address - Street 1:3259 CATLIN AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5109
Practice Address - Country:US
Practice Address - Phone:703-307-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife