MEDICARE: JAYDE MARIE SHAW MSN, APRN, PMHNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1218584	TX

General Provider Information

NPI Number	:	1215891684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYDE MARIE SHAW MSN, APRN, PMHNP

Provider Business Mailing Address
First Line	:	2000 WESTFALIAN TRL APT 6
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1977
Country	:	US
Telephone Number	:	432-251-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 6TH ST STE B
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-4700
Country	:	US
Telephone Number	:	806-853-5314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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