Individual provider Active NPI

Shannon Hansen Cook, MD

  • Psychiatry Physician
  • Johnson City, TN
National Provider Identifier
1356502389
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
53315 Issued in TN
Practice address
917 W Walnut St
Johnson City, TN 37604-6527
Phone
(423) 439-6464
NPI assigned
Jun 23, 2008
Last updated
Sep 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 53315 TN Primary
Psychiatry Physician 2084P0800X LL30894 SC
Addiction Medicine (Preventive Medicine) Physician 2083A0300X 53315 TN

Addresses

Primary practice location

917 W Walnut St
Johnson City, TN 37604-6527

Mailing address

PO Box 699
Mountain Home, TN 37684-0699

Other practice location 1

403 N State of Franklin Rd
Johnson City, TN 37604-6034
Phone (423) 431-7111

Other identifiers 1

IdentifierTypeStateIssuer
Q065146MedicaidTN

Other names 1

  • Shannon L Hansen Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210503001374 TN Practitioner - PsychiatryPractitioner - Addiction Medicine 3173932233 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Addiction Medicine
Education
East Tennessee State University Quillen College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

102 N Broadway St
Johnson City, TN 37601-3525
Phone (423) 588-9978

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
LL30894SCMDPsychiatry Physician
53315TNMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation CurrentSince Mar 1, 2022 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Medical Education Assistance Corporation Psychiatry CurrentSince Mar 29, 2021 Accepting new patients
Wellmont Medical Associates, Inc. Psychiatry CurrentSince Mar 1, 2022 Accepting new patients
Dragonfly Medical and Behavioral Health Professsional Corporation CurrentSince Dec 7, 2024 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Mar 1, 2022 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince Mar 1, 2022 Accepting new patients
Dragfonfly Wellness Center PastSince Dec 7, 2024 Accepting new patients

Locations

1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380

1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000

102 N Broadway St
Johnson City, TN 37601
Phone (423) 328-8265

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

403 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-7042

917 W Walnut St
Johnson City, TN 37604
Phone (423) 439-6464

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

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1356502389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 W WALNUT ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046527",
            "telephone_number": "423-439-6464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "403 N State of Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046034",
            "country_code": "US",
            "telephone_number": "423-431-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSEN COOK",
        "first_name": "SHANNON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "53315",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "LL30894",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "TN",
            "license": "53315",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q065146",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "HANSEN",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.