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General NPI Number Information
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NPI Number | 1124519822
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Entity Type | Individual
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Provider Name | SHANNON MICHELLE EATON MSN, FPMHNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 535 SE WASHINGTON ST
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City | HILLSBORO
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State | OR
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Zip | 97123-4142
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Country | US
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Telephone | 503-755-6703
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Fax | 503-755-6704
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Provider Business Mailing Address
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Address Line | 640 W REPUBLIC RD STE 108
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5816
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Country | US
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Telephone | 425-678-3582
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Fax | 417-356-8800
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 138149
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2018024368
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61106759
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10027243
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License Number State | OR
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