1649537036 NPI number — DR. SHANNON LEIGH CAIRNS D.P.M.

Table of content: DR. SHANNON LEIGH CAIRNS D.P.M. (NPI 1649537036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649537036 NPI number — DR. SHANNON LEIGH CAIRNS D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAIRNS
Provider First Name:
SHANNON
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARNETTE
Provider Other First Name:
SHANNON
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649537036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 DENTON HWY
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
WATAUGA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76148-1918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-656-0303
Provider Business Mailing Address Fax Number:
817-520-3223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 DENTON HWY
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
WATAUGA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76148-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-656-0303
Provider Business Practice Location Address Fax Number:
817-520-3223
Provider Enumeration Date:
04/23/2012

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: 213ES0103X , with the licence number:  2140 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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