Individual
SHANNON PERNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
513 MADISON AVE, COVINGTON, KY 41011-1562
(859) 431-3052
Mailing address
502 FARRELL DR, COVINGTON, KY 41011-3717
(859) 578-3204
(859) 578-3273
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1116481
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610661458
TAX ID
KY
Enumeration date
10/12/2015
Last updated
10/12/2015
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