Individual
SHANNON L MOFFETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF PULMONARY, JACKSON, MS 39216-4505
(601) 984-5650
(601) 984-5658
Mailing address
2500 N STATE ST, DIVISION OF PULMONARY, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R857161
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06188884
—
MS
01
—
P01648526
RAILROAD MEDICARE PTAN
MS
Enumeration date
10/23/2006
Last updated
06/29/2016
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