Provider Demographics
NPI:1356562656
Name:HAMLIN, SHANNAN KAY (MSN, RN, ACNP, CCRN)
Entity type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:KAY
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:MSN, RN, ACNP, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 AVALON CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4178
Mailing Address - Country:US
Mailing Address - Phone:281-487-2619
Mailing Address - Fax:713-441-4427
Practice Address - Street 1:6565 FANNIN ST # NB1-087
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-4043
Practice Address - Fax:713-441-4427
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601943363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y5457OtherBLUE CROSS BLUE SHIELD
TX154486802Medicaid
TX154486802Medicaid