Healthcare Provider Details

I. General information

NPI: 1619182078
Provider Name (Legal Business Name): SHANNON HILL SHELLEY C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON HILL NIRODE CNM

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 19TH STREET SUITE 509
KNOXVILLE TN
37916-1853
US

IV. Provider business mailing address

501 19TH STREET SUITE 509
KNOXVILLE TN
37916-1853
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-3208
  • Fax: 865-522-4322
Mailing address:
  • Phone: 865-524-3208
  • Fax: 865-522-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number11574
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: