Tucker, Shannon

Tucker, Shannon is an individual health care provider with primary practice located at 1215 Lee St , Charlottesville VA 22908-4500. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Tucker, Shannon can be contacted via phone (434) 243-3090.

Contact Information

Primary practice address
1215 Lee St Charlottesville VA 22908-4500
Phone: (434) 243-3090
Fax: (434) 244-9445
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA00245 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0110005762 Virginia

Profile Details

NPI number 1730575218
LBN Legal business name Tucker, Shannon
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2015
Last updated Sep 13th, 2017 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730575218 NPPES
Mississippi MEDICAID 05059577

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