MEDICARE: SHANNON SUE STONE FNP

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	1103040	TX

General Provider Information

NPI Number	:	1477265452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON SUE STONE FNP

Provider Business Mailing Address
First Line	:	2100 CENTER DR APT 411
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-4838
Country	:	US
Telephone Number	:	269-330-7075
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 COLLEGE DR
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-4004
Country	:	US
Telephone Number	:	940-552-9316
Fax Number	:

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

Provider Enumeration Date	:	12/21/2022
Last Update Date	:	12/21/2022

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Directions to “ SHANNON SUE STONE FNP” Practice Location

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