Provider Demographics
NPI:1407423189
Name:WHITE, SHANNON A
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 LONG PRAIRIE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5410
Mailing Address - Country:US
Mailing Address - Phone:972-639-1600
Mailing Address - Fax:972-639-1677
Practice Address - Street 1:4441 LONG PRAIRIE RD STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-5410
Practice Address - Country:US
Practice Address - Phone:972-639-1600
Practice Address - Fax:972-639-1677
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily