Shannon D Renick, DNP, APNP, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

7787-33 Issued in WI

Practice address

210 Independence Ave
Columbus, MS 39710-1269

Phone

(662) 434-1395

NPI assigned

Jul 18, 2017

Last updated

Jan 13, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Shannon D Graham Former name

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.renick.2@17762.direct.athenahealth.com

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.

• Dutch Medical Clinics, Inc

  dba Allegro Family Clinics

  • Multi-Specialty Clinic/Center
  • Columbus, MS
  • NPI 1215276175
  Medicare reassignment NPD
• Dutch Medical Clinics, Inc.

  dba Allegro Family Clinic of East Columbus

  • Family Medicine Physician
  • Columbus, MS
  • NPI 1639681976
  NPD (past)

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1386167799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 INDEPENDENCE",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397105300",
            "telephone_number": "624-341-3956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 INDEPENDENCE AVE",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397101269",
            "telephone_number": "662-434-1395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Bluecutt Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "MS",
            "postal_code": "397051303",
            "country_code": "US",
            "telephone_number": "662-570-4770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "56 Dutch Ln",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "MS",
            "postal_code": "397025500",
            "country_code": "US",
            "telephone_number": "662-329-3808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENICK",
        "first_name": "SHANNON",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DNP, APNP, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-18",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MS",
            "license": "907042",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WI",
            "license": "7787-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "GRAHAM",
            "middle_name": "D",
            "prefix": "MS.",
            "credential": "DNP, APNP, CPNP-PC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Quintara A Reese
• Region Seven Mental Health Idd Commission (Community Counseling Services)
• Rehab at Work of South Mississippi
• Rehab at Work PLLC
• Shaheem Ur Rehman, MD
• Revive Family Medical Clinic, LLC
• Revive Physical Therapy, LLC
• Andrew Scott Reynolds, OT
• Kaleigh Reynolds
• Charles S. Rhea Jr., MD

• Pediatric Nurse Practitioner in Columbus, MS
• Providers in Columbus, MS by specialty
• Pediatric Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.