Shannon Etheridge Whitten, M.S.,NP-C, APRN,BC,

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R117082 Issued in GA

Practice address

616 Ferncrest Dr
Sandersville, GA 31082-1863

Phone

(478) 864-3448

Fax

(478) 864-1288

NPI assigned

Nov 2, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Community Health Care Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Wrightsville, GA
  • NPI 1932150422
  Medicare reassignment NPD
• Community Health Care Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Sandersville, GA
  • NPI 1184515694
  NPD
• Southeast Georgia Primary Care

  • Family Medicine Physician
  • Waycross, GA
  • NPI 1053429688
  NPD
• Washington County Internal Medicine, P.C.

  • Internal Medicine Physician
  • Wrightsville, GA
  • NPI 1336390871
  NPD (past)

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

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1508045840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 FERNCREST DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310821863",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 FERNCREST DR",
            "city": "SANDERSVILLE",
            "state": "GA",
            "postal_code": "310821863",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITTEN",
        "first_name": "SHANNON",
        "middle_name": "ETHERIDGE",
        "name_prefix": "Mrs.",
        "credential": "M.S.,NP-C, APRN,BC,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-02",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "R117082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marvin Wells
• West Drug Co
• West Prescription Shop
• Lewis M. West, RPH
• Shanell White
• Erin Ashley Wilkes, FNP-C
• Lawanda Shaunta Williams, FNP
• Stacey Hodges Williford, NP
• Jessica Marie Womble
• Robert P Wright, M.D.

• Family Nurse Practitioner in Sandersville, GA
• Providers in Sandersville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.