Provider Demographics
NPI:1205838208
Name:CAIN, SHANNON DIONE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DIONE
Last Name:CAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:DIONE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2605 W CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-870-7936
Practice Address - Fax:903-957-0367
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02293363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197765401Medicaid
TX82N244OtherBLUE CROSS BLUE SHIELD
TX82N244OtherBLUE CROSS BLUE SHIELD
TXP00201452Medicare PIN
OK100158390AMedicaid