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General NPI Number Information
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NPI Number | 1164893889
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Entity Type | Individual
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Provider Name | SHANNON LYNN YOUNG DELACRUZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 302 E COMMERCE
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City | BROWNWOOD
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State | TX
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Zip | 76801
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Country | US
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Telephone | 325-510-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 BURNET RD
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City | BROWNWOOD
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State | TX
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Zip | 76801-8520
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Country | US
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Telephone | 325-646-8541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP129021
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License Number State | TX
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