Provider Demographics
NPI:1780840264
Name:BOLINGER, SHANNON C (PA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:STE 3500
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-0398
Mailing Address - Country:US
Mailing Address - Phone:469-303-4700
Mailing Address - Fax:469-303-4230
Practice Address - Street 1:7609 PRESTON RD
Practice Address - Street 2:STE 3500
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3214
Practice Address - Country:US
Practice Address - Phone:469-303-4700
Practice Address - Fax:469-303-4230
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2016-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05806363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical