Provider Demographics
NPI:1578513040
Name:GRAY, SHAWN ROONEY (MSN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:ROONEY
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MRS
Other - First Name:SHAWN
Other - Middle Name:FONTENOT
Other - Last Name:ROONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:857 E. VIRGINIA
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705
Mailing Address - Country:US
Mailing Address - Phone:409-880-8466
Mailing Address - Fax:409-880-7703
Practice Address - Street 1:857 E. VIRGINIA
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705
Practice Address - Country:US
Practice Address - Phone:409-880-8466
Practice Address - Fax:409-880-7703
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618115363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9839OtherBLUE CROSS BLUE SHIELD
TX8G4303Medicare ID - Type Unspecified
P50618Medicare UPIN