Provider Demographics
NPI:1821867714
Name:MOORE, SHAWNDRA DEAN (FNP)
Entity Type:Individual
Prefix:
First Name:SHAWNDRA
Middle Name:DEAN
Last Name:MOORE
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 1:710 S GREGG ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2425
Mailing Address - Country:US
Mailing Address - Phone:432-517-4692
Mailing Address - Fax:
Practice Address - Street 1:600 I-20 EAST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782
Practice Address - Country:US
Practice Address - Phone:143-252-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily