Provider Demographics
NPI:1881920353
Name:WILLIAMON, SHANE CLINTON I (CRNP)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:CLINTON
Last Name:WILLIAMON
Suffix:I
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1890
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36203
Mailing Address - Country:US
Mailing Address - Phone:256-236-8611
Mailing Address - Fax:256-236-8636
Practice Address - Street 1:901 KEITH AVENUE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36202
Practice Address - Country:US
Practice Address - Phone:256-236-8611
Practice Address - Fax:256-236-8636
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-078396363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care