Provider Demographics
NPI:1932981362
Name:DRISKILL, SHAWNNA (RN, CLC)
Entity Type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:
Last Name:DRISKILL
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S WASHINGTON ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3230
Mailing Address - Country:US
Mailing Address - Phone:662-549-5019
Mailing Address - Fax:
Practice Address - Street 1:202 S WASHINGTON ST UNIT 4
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3230
Practice Address - Country:US
Practice Address - Phone:662-549-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR878736163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty