Healthcare Provider Details

I. General information

NPI: 1134616436
Provider Name (Legal Business Name): SHANNON RENE BEARDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 SAINT MICHAEL DR STE 238
TEXARKANA TX
75503-2378
US

IV. Provider business mailing address

5002 COWHORN CREEK RD
TEXARKANA TX
75503-9766
US

V. Phone/Fax

Practice location:
  • Phone: 903-794-8820
  • Fax: 903-794-8878
Mailing address:
  • Phone: 903-614-3000
  • Fax: 903-614-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137261
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: