=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801218920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN HARRIS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2014
-----------------------------------------------------
Last Update Date | 03/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 S GREGG ST
-----------------------------------------------------
City | BIG SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79720-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-517-4557
-----------------------------------------------------
Fax | 432-517-4556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 W 11TH PL
-----------------------------------------------------
City | BIG SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79720-4119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-263-1211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 726445
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP124695
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------