Healthcare Provider Details

I. General information

NPI: 1659699221
Provider Name (Legal Business Name): SHANNEN LYNN DUMOND RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER ROAD
FORT CAVAZOS TX
76544
US

IV. Provider business mailing address

590 MEDICAL CENTER ROAD
FORT CAVAZOS TX
76544
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-3764
  • Fax: 254-288-8995
Mailing address:
  • Phone: 254-669-5454
  • Fax: 254-288-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number730972
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number730972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: