Provider Demographics
NPI:1639879687
Name:WALLS, SHANNA MARKELL (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MARKELL
Last Name:WALLS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448-2627
Mailing Address - Country:US
Mailing Address - Phone:254-629-1744
Mailing Address - Fax:254-629-3904
Practice Address - Street 1:400 W PLUMMER ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2627
Practice Address - Country:US
Practice Address - Phone:254-629-1744
Practice Address - Fax:254-629-3904
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112518363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner