Healthcare Provider Details

I. General information

NPI: 1801683479
Provider Name (Legal Business Name): MONICA GRACE SHOOPMAN MSN, FNP-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 JACKSBORO PIKE
JACKSBORO TN
37757-4850
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 423-201-9937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38696
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: