Provider Demographics
NPI:1871927343
Name:WEATHERS, SHANNON CREEL (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CREEL
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:CREEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:527 HIGHWAY 533
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-8871
Mailing Address - Country:US
Mailing Address - Phone:601-513-2129
Mailing Address - Fax:
Practice Address - Street 1:30 CIRCLE J DR
Practice Address - Street 2:#1
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1980
Practice Address - Country:US
Practice Address - Phone:601-425-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR880712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily