Moffett, Shannon L

Moffett, Shannon L is an individual health care provider with primary practice located at 2500 North State Street Department Of Medicine Division Of Pulmonary, Jackson MS 39216-4505. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Moffett, Shannon L can be contacted via phone (601) 984-5650.

Contact Information

Primary practice address
2500 North State Street Department Of Medicine Division Of Pulmonary Jackson MS 39216-4505
Phone: (601) 984-5650
Fax: (601) 984-5658
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X R857161 Mississippi

Profile Details

NPI number 1174606289
LBN Legal business name Moffett, Shannon L
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 23rd, 2006
Last updated Jun 29th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1174606289 NPPES
Mississippi MEDICAID 06188884
Mississippi Other P01648526

Popular Providers