Provider Demographics
NPI:1912401084
Name:REED, SHANNON (CNM, DNP)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:CNM, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 DOGPATCH DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75161-8165
Mailing Address - Country:US
Mailing Address - Phone:520-236-9599
Mailing Address - Fax:
Practice Address - Street 1:109 TEJAS DR STE 100
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-6582
Practice Address - Country:US
Practice Address - Phone:972-563-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136964367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife