Provider Demographics
NPI:1184410367
Name:MINOR, SHEVON (APRN)
Entity type:Individual
Prefix:
First Name:SHEVON
Middle Name:
Last Name:MINOR
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12408 DESSAU RD APT 7309
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-2259
Mailing Address - Country:US
Mailing Address - Phone:214-837-8137
Mailing Address - Fax:
Practice Address - Street 1:6210 E HWY 290 STE 450
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1143
Practice Address - Country:US
Practice Address - Phone:214-837-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041873363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology