Individual
SHANNON RIVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1040 RIVER OAKS DR, SUITE 103, FLOWOOD, MS 39232-9530
(601) 326-2599
(601) 933-0852
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6565
(601) 984-5658
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R820958
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06286014
—
MS
01
—
1336216431
GROUP NPI
MS
Enumeration date
08/27/2008
Last updated
09/14/2018
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