Provider Demographics
NPI:1770594236
Name:THOMPSON, SHANNON COLEMAN (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:COLEMAN
Last Name:THOMPSON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 NEW CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1614
Mailing Address - Country:US
Mailing Address - Phone:910-399-6797
Mailing Address - Fax:910-399-6622
Practice Address - Street 1:5036 NEW CENTRE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1614
Practice Address - Country:US
Practice Address - Phone:910-399-6797
Practice Address - Fax:910-399-6622
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201486363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2806439Medicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE