Provider Demographics
NPI:1801218920
Name:HARRIS, SHAWN (FNP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W 11TH PL
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4119
Mailing Address - Country:US
Mailing Address - Phone:432-263-1211
Mailing Address - Fax:
Practice Address - Street 1:1300 S GREGG ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4325
Practice Address - Country:US
Practice Address - Phone:432-517-4557
Practice Address - Fax:432-517-4556
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX726445163W00000X
TXAP124695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281971602Medicaid
TX726445OtherTEXAS BOARD OF NURSING