Healthcare Provider Details

I. General information

NPI: 1831478965
Provider Name (Legal Business Name): SHANNON SELBO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON SKINNER PA-C

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 BOSQUE BLVD
WACO TX
76710-4023
US

IV. Provider business mailing address

PO BOX 848476
DALLAS TX
75284-8476
US

V. Phone/Fax

Practice location:
  • Phone: 254-202-2600
  • Fax: 254-202-2650
Mailing address:
  • Phone: 254-202-4655
  • Fax: 254-202-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07219
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: