Active NPI
Shannon Revit, DNP, FNP-BC, RN
- Family Nurse Practitioner
- Elkton, MD
National Provider Identifier
1184029720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R230122
- Practice address
- 104 W Main St
Elkton, MD 21921-5509 - Phone
- (410) 996-8990
- Fax
- (410) 996-8992
- NPI assigned
- Oct 24, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R230122 | MD | Primary |
Addresses
Primary practice location
104 W Main St
Elkton, MD 21921-5509
Mailing address
104 W Main St
Elkton, MD 21921-5509
Phone (410) 996-8990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184029720 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R230122 | MD | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522108800000",
"number": "1184029720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 W MAIN ST",
"city": "ELKTON",
"state": "MD",
"postal_code": "219215509",
"telephone_number": "410-996-8990",
"fax_number": "410-996-8992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 W MAIN ST",
"city": "ELKTON",
"state": "MD",
"postal_code": "219215509",
"telephone_number": "410-996-8990",
"fax_number": "410-996-8992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVIT",
"first_name": "SHANNON",
"credential": "DNP, FNP-BC, RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-24",
"last_updated": "2018-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MD",
"license": "R230122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1184029720",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.