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NPI Code Detail

MEDICARE: SHANNON PENIX RN

MEDICARE: SHANNON PENIX RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WA0400XAddiction (Substance Use Disorder) Registered NurseRN.554893OH
2175T00000XPeer SpecialistAPS.006524OH

General Provider Information

NPI Number : 1063399707
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON PENIX RN
Provider Business Mailing Address
First Line : 2716 SCIOTO TRL
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-2500
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 729 6TH ST
Second Line :
City : PORTSMOUTH
State : OH
Zip : 45662-4030
Country : US
Telephone Number : 740-876-8290
Fax Number : 740-529-1205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2025
Last Update Date : 04/20/2026

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Directions to “ SHANNON PENIX RN” Practice Location

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