MEDICARE: MRS. SHANNON CHRISTINE BORDEN 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
1	363LF0000X	Family Nurse Practitioner	1099957	TX
2	363LF0000X	Family Nurse Practitioner	923510	TX

General Provider Information

NPI Number	:	1366152951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON CHRISTINE BORDEN FNP-C

Provider Business Mailing Address
First Line	:	10497 TOWN AND COUNTRY WAY STE 360
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1143
Country	:	US
Telephone Number	:	713-341-2100
Fax Number	:	713-932-7072

Provider Business Practice Location Address
First Line	:	10497 TOWN AND COUNTRY WAY STE 360
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1143
Country	:	US
Telephone Number	:	713-341-2100
Fax Number	:	713-932-7072

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/07/2022

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