Provider Demographics
NPI:1396298394
Name:DEDMON, SHANNON BRITTANY (FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BRITTANY
Last Name:DEDMON
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 1:4662 E CIRCLE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4101
Mailing Address - Country:US
Mailing Address - Phone:423-790-7662
Mailing Address - Fax:
Practice Address - Street 1:1970 JORDAN AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1900
Practice Address - Country:US
Practice Address - Phone:423-790-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily