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NPI Code Detail

MEDICARE: SHANNON PARKER FNP-C

MEDICARE: SHANNON PARKER FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner651266TX
2363LF0000XFamily Nurse PractitionerAP124123TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1651266OTHERTXTEXAS BOARD OF NURSING

General Provider Information

NPI Number : 1053744987
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON PARKER FNP-C
Provider Business Mailing Address
First Line : PO BOX 99213
Second Line :
City : FORT WORTH
State : TX
Zip : 76199-0213
Country : US
Telephone Number : 682-885-1855
Fax Number : 682-885-7347
Provider Business Practice Location Address
First Line : 10601 N RIVERSIDE DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-2118
Country : US
Telephone Number : 817-347-2600
Fax Number : 817-347-2650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2013
Last Update Date : 07/14/2020

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Directions to “ SHANNON PARKER FNP-C” Practice Location

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