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General NPI Number Information
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NPI Number | 1053103721
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Entity Type | Individual
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Provider Name | SHANNON NICOLE DART FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 11/08/2026
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Provider Practice Location Address
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Address Line | 901 HALSTEAD BLVD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-6920
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Country | US
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Telephone | 252-619-4629
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Fax |
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Provider Business Mailing Address
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Address Line | 112 SPARKS DR
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City | FOREST CITY
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State | NC
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Zip | 28043-9021
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Country | US
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Telephone | 828-351-6000
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Fax | 828-287-7436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 189029
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5022302
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License Number State | NC
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