Provider Demographics
NPI:1689969982
Name:BLEVINS, SHANNON DIANE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:DIANE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E. LAMAR ALEXANDER PKWY
Mailing Address - Street 2:2012 CHILHOWEE MEDICAL PARK
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-503-6865
Mailing Address - Fax:
Practice Address - Street 1:2020 E. LAMAR ALEXANDER PKWY
Practice Address - Street 2:2012 CHILHOWEE MEDICAL PARK
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-503-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily