Chaunta Wade Shannon

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

325286 Issued in MS

Practice address

1090 Eagles Brooke Dr
Locust Grove, GA 30248-2475

Phone

(419) 610-3721

NPI assigned

Mar 28, 2024

Sex

Female

Sole proprietor

Yes

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

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": "1711584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1831940741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 EAGLES BROOKE DR",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482475",
            "telephone_number": "419-610-3721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 EAGLES BROOKE DR",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302482475",
            "telephone_number": "419-610-3721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "CHAUNTA",
        "middle_name": "WADE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MS",
            "license": "325286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ericka Robinson Lockett
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• Chetan Sharma, M.D.
• Khani J Shaw
• Annie Felecia Sheets
• Diana Shekoury, OD
• Shield Care Transport LLC

• Licensed Practical Nurse in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.