Healthcare Provider Details

I. General information

NPI: 1225085079
Provider Name (Legal Business Name): NEXT GENERATION FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD SUITE O
LANSING MI
48912
US

IV. Provider business mailing address

1515 LAKE LANSING RD SUITE O
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-0781
  • Fax: 517-908-0752
Mailing address:
  • Phone: 517-853-0781
  • Fax: 517-908-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014250
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number5101014250
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003908
License Number StateMI

VIII. Authorized Official

Name: DR. SHANNON V MOBLEY
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 517-853-0781