Shawn Fortenberry Churchill Coy, FNP-BC, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Camden, TN
NPI 1255425922 · NPPES record last updated Aug 12, 2026
Key facts
- NPI
- 1255425922
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 905512 (MS)
- Practice address
- 190 W Main St
Camden, TN 38320-1609 - Phone
- (731) 213-2662
- Fax
- (731) 213-2539
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- DC Medical Services Inc
Dutch Medical Clinics, Inc
Iris Medical Group
Practice addresses (Care Compare)
190 W Main St
Camden, TN 38320-1609
Phone (731) 213-2662
3600 Bluecutt Rd
Columbus, MS 39705-1303
Phone (662) 570-4770
9019 Overlook Blvd
Suite C1B
Brentwood, TN 37027-2737
Phone (615) 274-9767
Hospital & facility affiliations
- Ascension Saint Thomas Three Rivers
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221007002050 | TN | Practitioner - Nurse Practitioner | 9739565185 | Reassigns benefits to 2 organizations |
| I20240411000035 | MS | Practitioner - Nurse Practitioner | 9739565185 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R789934 | MS | MD | Registered Nurse First Assistant |
| 905512 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
| APN0000032347 | TN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magnolia Regional Behavioral Health Services | Current |
Accepting new patients | |
| Iris Medical Group | Family | Current |
Accepting new patients |
| DC Medical Services Inc | Current |
Accepting new patients | |
| Family Care Clinic of Ripley | Current |
Accepting new patients | |
| Heale Counseling, LLC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Dutch Medical Clinics, Inc | Current |
Accepting new patients | |
| Iris Wound Care, PC | Past | Accepting new patients |
Locations
56 Dutch Ln
Columbus, MS 39702
Phone (662) 329-3808
3600 Bluecutt Rd
Columbus, MS 39705
Phone (662) 570-4770
3600 Bluecutt Rd
Ste 201
Columbus, MS 39705
Phone (662) 329-3973
3654B New Hope Rd
Columbus, MS 39702
Phone (662) 329-1488
401 Alcorn Dr
Ste 2C
Corinth, MS 38834
Phone (662) 286-9255
212 Alcorn Dr
Corinth, MS 38834
Phone (662) 287-9970
611 Alcorn Dr
Corinth, MS 38834
Phone (601) 286-6961
1305 City Ave N
Ripley, MS 38663
Phone (662) 372-3495
1331 City Ave N
Ripley, MS 38663
Phone (662) 993-9336
302 S Spring St
Tupelo, MS 38804
Phone (662) 841-8020
9019 Overlook Blvd
Ste C1B
Brentwood, TN 37027
190 W Main St
Camden, TN 38320
Phone (731) 213-2662
Interoperability endpoints
- shawn.churchill-coy.1@30029.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 905512 | MS | Yes |
| Registered Nurse First Assistant | 163WR0006X | R789934 | MS | |
| Family Nurse Practitioner | 363LF0000X | APN0000032347 | TN | |
| Family Nurse Practitioner | 363LF0000X | 905512 | MS | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | APN0000032347 | TN |
Addresses
Primary practice location
190 W Main St
Camden, TN 38320-1609
Mailing address
190 W Main St
Camden, TN 38320-1609
Phone (731) 213-2662
Other practice location 1
205A Hospital Dr
Mc Kenzie, TN 38201-2024
Phone (731) 352-7907
Other practice location 2
1894 Cedar St
Mc Kenzie, TN 38201-2206
Phone (731) 207-6496
Other practice location 3
30810 Broad St
Bruceton, TN 38317-2028
Phone (731) 586-4800
Other practice location 4
306 Highway 641 N
Camden, TN 38320-3012
Phone (731) 213-2344
Other practice location 5
205A Court Sq
Huntingdon, TN 38344-3710
Phone (731) 535-5765
Other practice location 6
1731 S Meridian St
Greenfield, TN 38230-1827
Phone (731) 678-0055
Other practice location 7
2051 US Highway 45 Byp S
Trenton, TN 38382-2940
Phone (731) 393-7120
Other providers in Camden, TN
- William Raymond Carney
- Matthew Carrico
- Mickie Carter
- CCC Medical Equipment, Inc.
- CCC Medical Equipment, Inc.
- Carlton Lynn Cole
- Christina Cole
- Core Men'S Health
- Debra L Davenport
- Jennifer Dawn Davis
All providers in Camden, TN · Psychiatric/Mental Health Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.