MEDICARE: SHANNON BRITTANY DEDMON FNP

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	363LF0000X	Family Nurse Practitioner	21453	TN

General Provider Information

NPI Number	:	1396298394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BRITTANY DEDMON FNP

Provider Business Mailing Address
First Line	:	4662 E CIRCLE DR NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4101
Country	:	US
Telephone Number	:	423-790-7662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 JORDAN AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-1900
Country	:	US
Telephone Number	:	423-790-7662
Fax Number	:

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

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	08/01/2016

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