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General NPI Number Information
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NPI Number | 1568065027
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Entity Type | Individual
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Provider Name | SHANNON MCCAIN NP
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1301 VETERANS MEMORIAL BLVD
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City | EUPORA
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State | MS
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Zip | 39744-2064
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Country | US
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Telephone | 662-258-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 220 CLARK AVE
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City | EUPORA
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State | MS
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Zip | 39744-2872
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Country | US
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Telephone | 662-418-6708
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 904206
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License Number State | MS
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