Provider Demographics
NPI:1588616833
Name:PEARCE, SHANNON E (ANP,GNP,C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:PEARCE
Suffix:
Gender:F
Credentials:ANP,GNP,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 BEN TAUB LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-816-4019
Mailing Address - Fax:
Practice Address - Street 1:711 W BAY AREA BLVD
Practice Address - Street 2:#500
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4043
Practice Address - Country:US
Practice Address - Phone:281-554-2200
Practice Address - Fax:281-554-4340
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669883363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160230202Medicaid
TX160230201Medicaid
TX160230202Medicaid
TXP91609Medicare UPIN
TX8J1728Medicare PIN
TX160230201Medicaid