Provider Demographics
NPI:1790316040
Name:SMITH, SHANNON MACHELLE (FNP-C,PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MACHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 HAPPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-8518
Mailing Address - Country:US
Mailing Address - Phone:704-819-6428
Mailing Address - Fax:
Practice Address - Street 1:7705 HAPPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-8518
Practice Address - Country:US
Practice Address - Phone:704-819-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF01200837363LF0000X, 363LP0808X
AL3-000628363LF0000X
OR0035870363LF0000X, 363LP0808X
FLAPRN1009335363LP0808X, 363LF0000X
AL3-00628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health