Healthcare Provider Details

I. General information

NPI: 1912401084
Provider Name (Legal Business Name): SHANNON REED CNM, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 TEJAS DR STE 100
TERRELL TX
75160-6582
US

IV. Provider business mailing address

1551 DOGPATCH DR
TERRELL TX
75161-8165
US

V. Phone/Fax

Practice location:
  • Phone: 972-563-3334
  • Fax:
Mailing address:
  • Phone: 520-236-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP136964
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: