1083853675 NPI number — MRS. SHANNON KAY RHOTON MSN, FNP-BC

Table of content: MRS. SHANNON KAY RHOTON MSN, FNP-BC (NPI 1083853675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083853675 NPI number — MRS. SHANNON KAY RHOTON MSN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOTON
Provider First Name:
SHANNON
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITING
Provider Other First Name:
SHANNON
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083853675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 LATHROP ST
Provider Second Line Business Mailing Address:
SUITE 217
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701-5930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-456-8191
Provider Business Mailing Address Fax Number:
907-456-8192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 LATHROP ST
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-5930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-456-8191
Provider Business Practice Location Address Fax Number:
907-456-8192
Provider Enumeration Date:
02/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1072 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 2004031239 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)