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General NPI Number Information
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NPI Number | 1922128198
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Entity Type | Individual
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Provider Name | SHUVON BLACKWELL RANKIN PMHNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 621 S MAIN ST STE 200
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City | REIDSVILLE
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State | NC
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Zip | 27320-5034
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Country | US
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Telephone | 336-349-4454
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Fax | 336-349-5186
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Provider Business Mailing Address
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Address Line | 1200 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1004
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5006408
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License Number State | NC
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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 | 5006408
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License Number State | NC
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