Healthcare Provider Details

I. General information

NPI: 1063068567
Provider Name (Legal Business Name): SHANNA KAY KLUN RN, BSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 N 1000 W STE B
LINTON IN
47441-5294
US

IV. Provider business mailing address

1185 N 1000 W
LINTON IN
47441-5282
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-3381
  • Fax: 812-847-9496
Mailing address:
  • Phone: 812-847-4481
  • Fax: 844-658-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28215527A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71009666A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: