Individual
JAMES DEANE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
300 FOXGLOVE DR, MT STERLING, KY 40353-9769
(859) 498-2135
(859) 498-7547
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0655
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350194
ANTHEM BCBS
—
05
—
30610026
—
KY
Enumeration date
09/02/2006
Last updated
07/08/2007
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