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General NPI Number Information
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NPI Number | 1376420570
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Entity Type | Individual
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Provider Name | SHAWNER TYSON PHLEBOTOMIST
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 665 S PEAR ORCHARD RD
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City | RIDGELAND
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State | MS
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Zip | 39157-4861
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Country | US
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Telephone | 601-921-5081
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Fax | 601-860-9834
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Provider Business Mailing Address
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Address Line | 5537 HIGHWAY 84
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City | PRENTISS
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State | MS
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Zip | 39474-4482
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Country | US
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Telephone | 601-441-8326
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Fax | 601-860-9834
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 063018-PWECW15312
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License Number State | MS
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