Individual
DR. SHANNON D RENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APNP, CPNP-PC
Contact information
Practice address
210 INDEPENDENCE AVE, COLUMBUS, MS 39710-1269
(662) 434-1395
Mailing address
201 INDEPENDENCE, COLUMBUS, MS 39710-5300
(624) 341-3956
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
7787-33
WI
363LP0200X
Pediatric Nurse Practitioner
907042
MS
Other
Enumeration date
07/18/2017
Last updated
01/13/2025
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