Healthcare Provider Details

I. General information

NPI: 1053197459
Provider Name (Legal Business Name): SHANNA M WALTERS DNP-FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 BAYFIELD PKWY
CONCORD NC
28027-7486
US

IV. Provider business mailing address

6150 BAYFIELD PKWY
CONCORD NC
28027-7486
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023087149
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: