Healthcare Provider Details

I. General information

NPI: 1366353260
Provider Name (Legal Business Name): SHANNON NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 TUSKA HINA
TROUT LA
71371-3822
US

IV. Provider business mailing address

PO BOX 14
JENA LA
71342-0014
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-4166
  • Fax: 318-220-1724
Mailing address:
  • Phone: 318-992-4166
  • Fax: 318-220-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: