Provider Demographics
NPI:1346286655
Name:BELL, SHANNON (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 YARWELL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 FAIRMONT PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3335
Practice Address - Country:US
Practice Address - Phone:281-991-0737
Practice Address - Fax:281-991-0738
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04011OtherSTATE LICENSE
TX8E0390Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
TXPA04011OtherSTATE LICENSE