Provider Demographics
NPI:1134616436
Name:BEARDEN, SHANNON RENE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RENE
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:5002 COWHORN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-9766
Mailing Address - Country:US
Mailing Address - Phone:903-614-3000
Mailing Address - Fax:903-614-3525
Practice Address - Street 1:2604 SAINT MICHAEL DR STE 238
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2378
Practice Address - Country:US
Practice Address - Phone:903-794-8820
Practice Address - Fax:903-794-8878
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP137261363LF0000X
AR124239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily