Healthcare Provider Details

I. General information

NPI: 1083853675
Provider Name (Legal Business Name): SHANNON KAY RHOTON MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON KAY WHITING

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST SUITE 217
FAIRBANKS AK
99701-5930
US

IV. Provider business mailing address

1919 LATHROP ST SUITE 217
FAIRBANKS AK
99701-5930
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-8191
  • Fax: 907-456-8192
Mailing address:
  • Phone: 907-456-8191
  • Fax: 907-456-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1072
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2004031239
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: