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NPI Code Detail

MEDICARE: MARILYN GENNEDY SHOOK PA

MEDICARE: MARILYN GENNEDY SHOOK PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA05255TX
2363AM0700XMedical Physician AssistantPA05255TX
3363AS0400XSurgical Physician AssistantPA05255TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18J7704OTHERTXMEDICARE INDIVIDUAL PTAN

General Provider Information

NPI Number : 1750582847
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN GENNEDY SHOOK PA
Provider Business Mailing Address
First Line : PO BOX 207
Second Line :
City : HOUSTON
State : TX
Zip : 77001-0207
Country : US
Telephone Number : 281-829-2000
Fax Number :
Provider Business Practice Location Address
First Line : 18885 KATY FWY FL 2
Second Line :
City : HOUSTON
State : TX
Zip : 77094-1103
Country : US
Telephone Number : 281-829-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 04/22/2025

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Directions to “ MARILYN GENNEDY SHOOK PA” Practice Location

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