Provider Demographics
NPI:1932135993
Name:HARKRIDER, SHAWN M (HIS)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:M
Last Name:HARKRIDER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 DOVE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3166
Mailing Address - Country:US
Mailing Address - Phone:817-657-8647
Mailing Address - Fax:817-764-6282
Practice Address - Street 1:9500 RAY WHITE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9104
Practice Address - Country:US
Practice Address - Phone:817-745-4572
Practice Address - Fax:817-764-6282
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50699237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist