1588616833 NPI number — SHANNON E PEARCE ANP,GNP,C

Table of content: SHANNON E PEARCE ANP,GNP,C (NPI 1588616833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588616833 NPI number — SHANNON E PEARCE ANP,GNP,C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARCE
Provider First Name:
SHANNON
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP,GNP,C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588616833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1504 BEN TAUB LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-816-4019
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 W BAY AREA BLVD
Provider Second Line Business Practice Location Address:
#500
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-554-2200
Provider Business Practice Location Address Fax Number:
281-554-4340
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  669883 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LG0600X , with the licence number: 669883 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160230202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160230201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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