Healthcare Provider Details

I. General information

NPI: 1972053627
Provider Name (Legal Business Name): SHANNON BURKHART FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KETTERING WAY STE 100
FRANKLIN OH
45005-1155
US

IV. Provider business mailing address

909 E 2ND ST
FRANKLIN OH
45005-1700
US

V. Phone/Fax

Practice location:
  • Phone: 937-746-8357
  • Fax:
Mailing address:
  • Phone: 937-746-8357
  • Fax: 937-746-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019907
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: