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NPI Code Detail

MEDICARE: SHANNON SMITH NP

MEDICARE: SHANNON SMITH NP
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
1363LF0000XFamily Nurse Practitioner1016925TX

General Provider Information

NPI Number : 1912507419
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON SMITH NP
Provider Business Mailing Address
First Line : PO BOX 1326
Second Line :
City : MARSHALL
State : TX
Zip : 75671-1326
Country : US
Telephone Number : 903-927-3782
Fax Number : 903-927-1764
Provider Business Practice Location Address
First Line : 1408 COLLEGE DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-3534
Country : US
Telephone Number : 903-791-1110
Fax Number : 903-791-9353
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2020
Last Update Date : 04/09/2026

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