Shannon Willis

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

239107 Issued in NC

Practice address

1121 N Church St
Greensboro, NC 27401-1007

Phone

(336) 832-3358

NPI assigned

Jan 17, 2026

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

Other names 1

• Shannon Lee Cannon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1768608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768608000000",
    "number": "1700745692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8200 JOE JESSUP CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274559355",
            "telephone_number": "336-337-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 N CHURCH ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011007",
            "telephone_number": "336-832-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-17",
        "last_updated": "2026-01-17",
        "certification_date": "2026-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": "239107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "CANNON",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peggy Dee Williford, CRNA
• Mary A. Willingham, LPC
• Benjamin T Willis, M.S., ED.S., NCC
• Charles Keith Willis, M.D.
• Katherine Willis
• Andrea E. Willoughby, LCSW, LCAS
• Willows Place Services
• Samantha Marie Wilmoth, LCSWA
• Wilson Counseling and Wellness, PLLC
• Myra Joy Wilson-Southerland, R.PH.

• Student in an Organized Health Care Education/Training Program in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Student in an Organized Health Care Education/Training Program in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.