Healthcare Provider Details

I. General information

NPI: 1568383602
Provider Name (Legal Business Name): SHANNON NICOLE PARKER MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 DUKE DR STE 202
MASON OH
45040-9010
US

IV. Provider business mailing address

4256 FIELDSEDGE DR
MASON OH
45040-8539
US

V. Phone/Fax

Practice location:
  • Phone: 937-759-0545
  • Fax: 937-759-0549
Mailing address:
  • Phone: 513-383-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042750
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: