Healthcare Provider Details

I. General information

NPI: 1710812185
Provider Name (Legal Business Name): SHANNA HONKOMP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 UNIVERSITY DR E STE 135
BRYAN TX
77802-3481
US

IV. Provider business mailing address

2500 WHISPERING OAKS CIR
BRYAN TX
77802-2023
US

V. Phone/Fax

Practice location:
  • Phone: 979-703-1832
  • Fax:
Mailing address:
  • Phone: 979-204-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1039577
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: