Healthcare Provider Details

I. General information

NPI: 1245540137
Provider Name (Legal Business Name): SUSAN MICHELLE SHORT FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7008 SALEM AVE STE 117
LUBBOCK TX
79424-2226
US

IV. Provider business mailing address

440 N BARRANCA AVE # 1801
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 800-924-7811
  • Fax: 877-349-1868
Mailing address:
  • Phone: 800-924-7811
  • Fax: 877-349-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025049885
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0040582
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number628756
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP115646
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704434851
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: