Provider Demographics
NPI:1245668425
Name:BOYD, SHANNON ELIZABETH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:BOYD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 SCOTT ST STE 113
Mailing Address - Street 2:
Mailing Address - City:TYE
Mailing Address - State:TX
Mailing Address - Zip Code:79563-2225
Mailing Address - Country:US
Mailing Address - Phone:325-701-7977
Mailing Address - Fax:325-692-1076
Practice Address - Street 1:649 SCOTT ST STE 113
Practice Address - Street 2:
Practice Address - City:TYE
Practice Address - State:TX
Practice Address - Zip Code:79563
Practice Address - Country:US
Practice Address - Phone:325-701-7977
Practice Address - Fax:325-692-1076
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX722902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily