Healthcare Provider Details

I. General information

NPI: 1356288815
Provider Name (Legal Business Name): JENNIFER SHAWN MAHAN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 MISTY LN
SPRING BRANCH TX
78070-5714
US

IV. Provider business mailing address

745 MISTY LN
SPRING BRANCH TX
78070-5714
US

V. Phone/Fax

Practice location:
  • Phone: 360-485-6074
  • Fax: --
Mailing address:
  • Phone: 360-485-6074
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number317658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: