Healthcare Provider Details

I. General information

NPI: 1861830200
Provider Name (Legal Business Name): SHAWN MICHAEL WHITFIELD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 SPARTA ST STE 21
MCMINNVILLE TN
37110-1376
US

IV. Provider business mailing address

1100 ENGLAND DR
COOKEVILLE TN
38501-0924
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-8468
  • Fax:
Mailing address:
  • Phone: 931-520-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17704
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: