MEDICARE: MS. CONNIE SHEPHERD SWANSON PMHNP/MSN

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	363L00000X	Nurse Practitioner	224525	TX
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	224525	TX

General Provider Information

NPI Number	:	1548492572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE SHEPHERD SWANSON PMHNP/MSN

Provider Business Mailing Address
First Line	:	6758 RIDGEWAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5938
Country	:	US
Telephone Number	:	713-649-4860
Fax Number	:

Provider Business Practice Location Address
First Line	:	6758 RIDGEWAY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5938
Country	:	US
Telephone Number	:	713-649-4860
Fax Number	:

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

Provider Enumeration Date	:	08/08/2009
Last Update Date	:	08/08/2009

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