Active NPI
Shannon R Warren, CFNP
- Family Nurse Practitioner
- Tupelo, MS
National Provider Identifier
1497800833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R867515
- Practice address
- 1542 Medical Park Cir
Tupelo, MS 38801-6560 - Phone
- (662) 844-4711
- Fax
- (662) 844-9619
- NPI assigned
- Jan 24, 2007
- 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 | R867515 | MS | Primary |
Addresses
Primary practice location
1542 Medical Park Cir
Tupelo, MS 38801-6560
Mailing address
1542 Medical Park Cir
Tupelo, MS 38801-6560
Phone (662) 844-4711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| APPLIED FOR | Medicaid | MS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R867515 | MS | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497800833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1542 MEDICAL PARK CIR",
"city": "TUPELO",
"state": "MS",
"postal_code": "388016560",
"telephone_number": "662-844-4711",
"fax_number": "662-844-9619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1542 MEDICAL PARK CIR",
"city": "TUPELO",
"state": "MS",
"postal_code": "388016560",
"telephone_number": "662-844-4711",
"fax_number": "662-844-9619"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARREN",
"first_name": "SHANNON",
"middle_name": "R",
"credential": "CFNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "R867515",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "APPLIED FOR",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.