SHANNON G. BOUCHILLON – NPI #1831082304
Family Medicine

The NUCC recommends this code not be used. Choose a more appropriate code.

SHANNON BOUCHILLON is a physician located in SOUTHAVEN, MS. NPPES has assigned the NPI number 1831082304 to SHANNON BOUCHILLON on June 02, 2025. It is a Type-1 NPI, indicating this NPI number is associated with an individual. The primary taxonomy selected by this provider is 207QA0505X from the Health Care Provider Taxonomy code set, which is classified as Family Medicine, specializing in Adult Medicine

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SHANNON BOUCHILLON below.

NPI Profile for
SHANNON G. BOUCHILLON

NPI Number
1831082304
Enumeration Date

(about a year ago)
Entity Type
Type-1  Individual (Female)
Legal Name
SHANNON G. BOUCHILLON
Primary location
6376 SILO SQUARE LN STE 104
SOUTHAVEN, MS 38672-1115
Phone: (662) 470-7812 Fax:
Mailing address
Same as primary location
Sole Proprietor
No
Updated
Certification Date
Jun 02, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207QA0505X
- Family Medicine / Adult Medicine (Primary)
MS 907150

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.