Provider Demographics
NPI:1114360740
Name:KALAGE, SHANNA LYNN (MSN,RN,AGNP-C,ANP-C)
Entity Type:Individual
Prefix:MISS
First Name:SHANNA
Middle Name:LYNN
Last Name:KALAGE
Suffix:
Gender:F
Credentials:MSN,RN,AGNP-C,ANP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:115 STONE CANYON
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-6300
Mailing Address - Country:US
Mailing Address - Phone:203-695-4680
Mailing Address - Fax:
Practice Address - Street 1:1619 E COMMON ST STE 1201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3464
Practice Address - Country:US
Practice Address - Phone:830-620-0330
Practice Address - Fax:830-620-5405
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner