SHANNON L MOFFETT NP NPI 1174606289

NPI Information

NPI: 1174606289
Provider Name: SHANNON L MOFFETT, NP
Classification: Nurse Practitioner - 363LA2100X
Entity Type: Individual

Specialization: Acute Care

PECOS Registration: Yes

Address:
2500 NORTH STATE STREET
DEPARTMENT OF MEDICINE DIVISION OF PULMONARY
JACKSON, MS
ZIP 39216
Phone: (601) 984-5650
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Shannon L Moffett, NP is an acute care nurse practitioner in Jackson, MS with 18 years of experience. Shannon L Moffett, NP NPI is 1174606289. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2500 NORTH STATE STREET
DEPARTMENT OF MEDICINE DIVISION OF PULMONARY
JACKSON, MS
ZIP 39216-505
Phone: (601) 984-5650
Fax: (601) 984-5658

The NPI 1174606289 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/23/2006 and was last updated on 6/29/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2100X	Nurse Practitioner	Acute Care	R857161	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P01648526	OTHER	MISSISSIPPI	RAILROAD MEDICARE PTAN
2	302I508859	MEDICARE PIN	MISSISSIPPI
3	06188884	MEDICAID	MISSISSIPPI
4	302I506454	MEDICARE PIN	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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