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NPI Code Detail

MEDICARE: SHANNON SMITH NP-C

MEDICARE: SHANNON SMITH NP-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 PractitionerAP131973TX

General Provider Information

NPI Number : 1306395777
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON SMITH NP-C
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 800-994-0371
Fax Number : 254-215-9722
Provider Business Practice Location Address
First Line : 2401 S 31ST ST
Second Line :
City : TEMPLE
State : TX
Zip : 76508-0001
Country : US
Telephone Number : 254-724-7603
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2016
Last Update Date : 03/30/2026

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Directions to “ SHANNON SMITH NP-C” Practice Location

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