MRS. SHANNON JOHNSON YOUNGER (NPI# 1164961629) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164961629 |
| Entity Type | Individual |
| Full Name | MRS. SHANNON JOHNSON YOUNGER |
| Other Name | MRS. SHANNON LUPE JOHNSON |
| Credential | PA-C |
| Practice Address |
724 Leigh Dr Columbus MS 39705-3098 |
| Practice Telephone | 6623283375 |
| Practice Fax Number | 6623283395 |
| Mailing Telephone | 6623283375 |
| Mailing Fax Number | 6623283395 |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2020-04-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA9110198 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | MISSISSIPPI PA CERTIFICATE | PA00395 | 01 |
| FL | 59-2455010 | PA9110198 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 724 Leigh Dr, Columbus, MS 39705 | 6623283375 | 6623283395 |
| 321 University Dr, Starkville, MS 397592956 | 6623235377 | 6623235377 |
| Street Address |
724 LEIGH DR |
| City | COLUMBUS |
| State | MS |
| Zip Code | 39705-3098 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871513721 | Bethany Hairston | Dermatology | 724 Leigh Dr, Columbus, MS 39705-3098 | 2006-07-20 |
| 1427250935 | Anna E. Woodson | Dermatology | 724 Leigh Dr, Columbus, MS 39705-3098 | 2007-06-05 |
| 1376670570 | Kala Nicole White | Nurse Practitioner | 724 Leigh Dr, Columbus, MS 39705-3098 | 2007-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255854527 | Kelly Christi Lovelace | Counselor | 428 24th Ave. North, Columbus, MS 39705 | 2017-07-19 |
| 1427505742 | National Vision, Inc. | Technician/Technologist | Bldg 160 Simler Blvd, Columbus, MS 39705 | 2016-09-02 |
| 1093165714 | Holly Murphy | Audiologist | 2430 4th Street North, Columbus, MS 39705 | 2016-06-14 |
| 1275951972 | Oleg Kalsow | Dentist | 300 Hospital Dr Ste 4, Columbus, MS 39705 | 2014-03-31 |
| 1982906509 | Gtrec, Inc. | Optometrist | 1913 Hwy. 45 N., Suite A, Columbus, MS 39705 | 2010-12-02 |
| 1295042919 | Emily Morgan Sesser | Nurse Practitioner | 4508 Hwy 45 N, Columbus, MS 39705 | 2010-09-01 |
| 1528298189 | Matthew Duane Williams | Internal Medicine | 2520 Fifth Street, North, Columbus, MS 39705 | 2009-07-16 |
| 1114156858 | Andrea Nicole Morris | Pediatrics | 2600 Fifth Street North, Columbus, MS 39705 | 2009-07-02 |
| 1124272307 | Paul J Scurti | Internal Medicine | 255 Baptist Blvd Ste 301, Columbus, MS 39705 | 2008-11-13 |
| 1073702171 | Heart To Heart Hospice of Columbus LLC | Hospice Care, Community Based | 2018 Hwy 45 N, Columbus, MS 39705 | 2007-10-15 |
| Find all providers in zip 39705 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972960359 | Autumn Combs | Physician Assistant | 437 N Gould Rd Apt F, Columbus, OH 43209-1139 | 2016-01-15 |
| 1740665926 | Julianne Gonzalez | Physician Assistant | 350 Manchester Expy, Columbus, GA 31904-6435 | 2015-07-29 |
| 1629461165 | Michael Bryant | Physician Assistant | 911 Rudgate Rd, Columbus, GA 31904-2948 | 2015-03-09 |
| 1174880447 | Ricky Lee Martin Jr. | Physician Assistant | 2326 18th St Ste 210, Columbus, IN 47201-5362 | 2012-04-11 |
| 1710068374 | April K Howell | Physician Assistant | 2008 Wynnton Rd, Columbus, GA 31906-2407 | 2006-10-18 |
| 1124035399 | Diane L. Mitchell | Physician Assistant | 1130 Talbotton Rd, Columbus, GA 31904-8749 | 2006-08-01 |
| 1194752790 | Karen L Goodale | Physician Assistant | 2881 Nc Hwy 108 E, Columbus, NC 28722-7721 | 2006-06-27 |
| 1164469979 | Mark H Epps | Physician Assistant | 2000 10th Ave Ste 270, Columbus, GA 31901-3706 | 2006-06-01 |
| 1164484689 | Jim Lawrence Mcevers | Physician Assistant | 109 Shult Dr, Suite 101, Columbus, TX 78934-3015 | 2006-04-03 |
| 1972586287 | Susan A Farwell | Physician Assistant | 45 E Mills St, Columbus, NC 28722 | 2005-11-22 |
| Find all providers in COLUMBUS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.