=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669777272
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNA RENAE CLAWSON PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2011
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 S HAMPTON RD STE 900
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75224-1677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-330-9201
-----------------------------------------------------
Fax | 214-339-9577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 S HAMPTON RD STE 900
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75224-1677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-330-9201
-----------------------------------------------------
Fax | 214-339-9577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA07084
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA07084
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------