Individual
MRS. SHANNON D DORRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
350 W WOODROW WILSON AVE, JACKSON, MS 39213-7681
(601) 983-1385
Mailing address
219 CRESCENT H DR, TERRY, MS 39170-8745
(601) 983-1385
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R863922
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01953308
—
MS
Enumeration date
11/18/2011
Last updated
09/23/2016
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