Healthcare Provider Details

I. General information

NPI: 1770594236
Provider Name (Legal Business Name): SHANNON COLEMAN THOMPSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5036 NEW CENTRE DR
WILMINGTON NC
28403-1614
US

IV. Provider business mailing address

5036 NEW CENTRE DR
WILMINGTON NC
28403-1614
US

V. Phone/Fax

Practice location:
  • Phone: 910-399-6797
  • Fax: 910-399-6622
Mailing address:
  • Phone: 910-399-6797
  • Fax: 910-399-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201486
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201486
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: