MEDICARE: SHANNON BURKHART 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	APRN.CNP.019907	OH

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

General Provider Information

NPI Number	:	1972053627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BURKHART FNP

Provider Business Mailing Address
First Line	:	909 E 2ND ST
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-1700
Country	:	US
Telephone Number	:	937-746-8357
Fax Number	:	937-746-1992

Provider Business Practice Location Address
First Line	:	100 KETTERING WAY STE 100
Second Line	:
City	:	FRANKLIN
State	:	OH
Zip	:	45005-1155
Country	:	US
Telephone Number	:	937-746-8357
Fax Number	:

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

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	10/30/2024

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Directions to “ SHANNON BURKHART FNP” Practice Location

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