Healthcare Provider Details

I. General information

NPI: 1417549569
Provider Name (Legal Business Name): SHANDEL PANNETON APRN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE
FORT HOOD TX
76544-5060
US

IV. Provider business mailing address

11036 LA PALOMA LOOP W
SALADO TX
76571-6340
US

V. Phone/Fax

Practice location:
  • Phone: 254-286-7602
  • Fax:
Mailing address:
  • Phone: 254-346-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAP132932
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number912783
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: