MEDICARE: SHANNON MERIE ATCHLEY APRN

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	232690	LA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1110410	TX

General Provider Information

NPI Number	:	1750976916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MERIE ATCHLEY APRN

Provider Business Mailing Address
First Line	:	709 ANDERSON ST
Second Line	:
City	:	NEW BOSTON
State	:	TX
Zip	:	75570-2205
Country	:	US
Telephone Number	:	931-561-4379
Fax Number	:

Provider Business Practice Location Address
First Line	:	17101 PRESTON RD STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-1369
Country	:	US
Telephone Number	:	972-544-1201
Fax Number	:	214-377-1576

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

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	02/17/2025

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