MEDICARE: SHANNON LOUANNE DUVALL PMHNP

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	961262	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1202647	TX

General Provider Information

NPI Number	:	1891639365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LOUANNE DUVALL PMHNP

Provider Business Mailing Address
First Line	:	106 AUSTIN AVE STE 202
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-3381
Country	:	US
Telephone Number	:	682-789-3659
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 AUSTIN AVE STE 202
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-3381
Country	:	US
Telephone Number	:	682-789-3659
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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