MEDICARE: SHANNON REBECCA ATCHISON FNP

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
1	363LF0000X	Family Nurse Practitioner	APN11667	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4304484	OTHER		BCBS
3	APN0000011667	OTHER	TN	STATE LICENSE

General Provider Information

NPI Number	:	1902950850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON REBECCA ATCHISON FNP

Provider Business Mailing Address
First Line	:	P.O. BOX 92
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-1256
Country	:	US
Telephone Number	:	731-836-9444
Fax Number	:	731-836-9443

Provider Business Practice Location Address
First Line	:	115 W TIGRETT ST
Second Line	:	APT A
City	:	HALLS
State	:	TN
Zip	:	38040-1256
Country	:	US
Telephone Number	:	731-836-9444
Fax Number	:	731-836-9443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/01/2021

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