Individual provider Active NPI

Shannon Oliver, NP-C

  • Nurse Practitioner
  • Knoxville, TN
National Provider Identifier
1265086003
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
25940 Issued in TN
Practice address
9320 Park West Blvd
Knoxville, TN 37923-4301
Phone
(865) 373-7100
Fax
(865) 374-2029
NPI assigned
Jul 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 25940 TN Primary

Addresses

Primary practice location

9320 Park West Blvd
Knoxville, TN 37923-4301

Mailing address

9320 Park West Blvd
Knoxville, TN 37923-4301
Phone (865) 373-7100

Other identifiers 1

IdentifierTypeStateIssuer
Q054759MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address oliver.shannon@covenanthealth.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200112000002 TN Practitioner - Nurse Practitioner 3072948546 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Lincoln Memorial University Medical Department, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

9320 Parkwest Blvd
Knoxville, TN 37923-4301
Phone (865) 373-7100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group, Inc. CurrentSince Jan 17, 2022 Accepting new patients
Covenant Medical Group, Inc CurrentSince Jan 17, 2022 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Nov 10, 2019 Accepting new patients
Wellmont Medical Associates Inc Nurse Practitioner CurrentSince Nov 10, 2019 Accepting new patients

Locations

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

9320 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-7100

Dept 888179
Knoxville, TN 37995

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1265086003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9320 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234301",
            "telephone_number": "865-373-7100",
            "fax_number": "865-374-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9320 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234301",
            "telephone_number": "865-373-7100",
            "fax_number": "865-374-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "SHANNON",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-30",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "25940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q054759",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oliver.shannon@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "9320 Park West Blvd",
            "city": "Knoxville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "379234301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.