Healthcare Provider Details

I. General information

NPI: 1245241066
Provider Name (Legal Business Name): SHANNA BARRY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/20/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 RED RIVER ST STE 201
AUSTIN TX
78705-2655
US

IV. Provider business mailing address

3706 S 1ST ST
AUSTIN TX
78704-7046
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-8375
  • Fax:
Mailing address:
  • Phone: 512-324-4973
  • Fax: 512-324-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number613974
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP114625
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: