Provider Demographics
NPI:1245518281
Name:CRAVEN, SHANNON MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:MICHELLE
Other - Last Name:CRAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5 REGIONAL CIR STE B&C
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9796
Mailing Address - Country:US
Mailing Address - Phone:910-295-1761
Mailing Address - Fax:910-295-2937
Practice Address - Street 1:5 REGIONAL CIR STE C
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9796
Practice Address - Country:US
Practice Address - Phone:910-295-1761
Practice Address - Fax:910-295-2937
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005287363AM0700X
NC0010-03058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical