Healthcare Provider Details

I. General information

NPI: 1275444614
Provider Name (Legal Business Name): EDEN AESTHETICS AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3926 S TREADAWAY BLVD STE A-2
ABILENE TX
79602-6901
US

IV. Provider business mailing address

3926 S TREADAWAY BLVD STE A-2
ABILENE TX
79602-6901
US

V. Phone/Fax

Practice location:
  • Phone: 325-201-2984
  • Fax:
Mailing address:
  • Phone: 325-201-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNA GAMBLE
Title or Position: OWNER/ PROVIDER
Credential: NP
Phone: 325-201-2984