Provider Demographics
NPI:1114354206
Name:VARNER, SHANNON LAINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LAINE
Last Name:VARNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:LAINE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8000 RESEARCH FOREST DR STE 360
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1559
Mailing Address - Country:US
Mailing Address - Phone:281-292-1191
Mailing Address - Fax:
Practice Address - Street 1:8000 RESEARCH FOREST DR STE 360
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1559
Practice Address - Country:US
Practice Address - Phone:281-292-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant