Provider Demographics
NPI:1629308580
Name:CAMPBELL, SHANNON O (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:O
Last Name:CAMPBELL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2499 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:BUILDING B, SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7762
Mailing Address - Country:US
Mailing Address - Phone:512-328-7666
Mailing Address - Fax:512-328-3547
Practice Address - Street 1:2499 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BUILDING B, SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7762
Practice Address - Country:US
Practice Address - Phone:512-328-7666
Practice Address - Fax:512-328-3547
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01960363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical