MEDICARE: SHANNON KENDRA HENRY CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	0024179769	VA

General Provider Information

NPI Number	:	1225649742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON KENDRA HENRY CPNP

Provider Business Mailing Address
First Line	:	601 CHILDRENS LN
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1971
Country	:	US
Telephone Number	:	757-668-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 HILLPOINT BOULEVARD, SOUTH
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434
Country	:	US
Telephone Number	:	757-668-2250
Fax Number	:	757-668-2255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	06/03/2026

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