Provider Demographics
NPI:1932545001
Name:SHANNON, KATHERINE VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:VIRGINIA
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:SHANNON
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:815 RUGBY PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5619
Mailing Address - Country:US
Mailing Address - Phone:502-821-3898
Mailing Address - Fax:
Practice Address - Street 1:1461 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7751
Practice Address - Country:US
Practice Address - Phone:812-280-7063
Practice Address - Fax:812-218-8557
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01082887A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology