MEDICARE: SHANNON BRACKETT HINKLE, PA-C, PLLC

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	363AS0400X	Surgical Physician Assistant	PA3510	FL

General Provider Information

NPI Number	:	1518991058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNON BRACKETT HINKLE, PA-C, PLLC

Provider Business Mailing Address
First Line	:	6411 WATERS EDGE DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-8925
Country	:	US
Telephone Number	:	252-442-7462
Fax Number	:	252-446-7463

Provider Business Practice Location Address
First Line	:	6411 WATERS EDGE DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-8925
Country	:	US
Telephone Number	:	252-442-7462
Fax Number	:	252-446-7463

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHANNON BRACKETT HINKLE III
Credential	:	PA-C
Telephone Number	:	252-442-7462

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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