Provider Demographics
NPI:1649537036
Name:CAIRNS, SHANNON LEIGH (DPM)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEIGH
Last Name:CAIRNS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:BARNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6900 DENTON HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1918
Mailing Address - Country:US
Mailing Address - Phone:817-656-0303
Mailing Address - Fax:817-520-3223
Practice Address - Street 1:6900 DENTON HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-1918
Practice Address - Country:US
Practice Address - Phone:817-656-0303
Practice Address - Fax:817-520-3223
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2140213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX472937123OtherTIN
TX472937123OtherTIN