Provider Demographics
NPI:1528396983
Name:SHIRLEY, KAREN D (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:D
Other - Last Name:WOODHULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 WEST LOOP SOUTH
Mailing Address - Street 2:STE 400B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-277-2222
Mailing Address - Fax:
Practice Address - Street 1:1381 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2846
Practice Address - Country:US
Practice Address - Phone:830-249-9424
Practice Address - Fax:830-249-9607
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L22582Medicare PIN