Provider Demographics
NPI:1154833135
Name:DENARD, SHANNON (CHW, BND)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DENARD
Suffix:
Gender:F
Credentials:CHW, BND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 S. M.L. KING JR. PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701
Mailing Address - Country:US
Mailing Address - Phone:409-678-1530
Mailing Address - Fax:409-833-4350
Practice Address - Street 1:1595 S. M.L. KING JR. PARKWAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701
Practice Address - Country:US
Practice Address - Phone:409-678-1530
Practice Address - Fax:409-833-4350
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSHD012012175F00000X
TX8058172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175F00000XOther Service ProvidersNaturopath