Provider Demographics
NPI:1750976916
Name:ATCHLEY, SHANNON MERIE (APRN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MERIE
Last Name:ATCHLEY
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 1:709 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2205
Mailing Address - Country:US
Mailing Address - Phone:931-561-4379
Mailing Address - Fax:
Practice Address - Street 1:17101 PRESTON RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1369
Practice Address - Country:US
Practice Address - Phone:972-544-1201
Practice Address - Fax:214-377-1576
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA232690363LP0808X
TX1110410363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health