MEDICARE: BREANNA SHENK NP

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	906040	MS

General Provider Information

NPI Number	:	1659051621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA SHENK NP

Provider Business Mailing Address
First Line	:	2798 PASS RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-2626
Country	:	US
Telephone Number	:	720-556-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2798 PASS RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-2626
Country	:	US
Telephone Number	:	720-556-0599
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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