Basic Information
| Provider Information | |||||||||
| NPI: | 1801218920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | SHAWN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 W 11TH PL | ||||||||
| Address2: | |||||||||
| City: | BIG SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797204119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322631211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 S GREGG ST | ||||||||
| Address2: | |||||||||
| City: | BIG SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797204325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325174557 | ||||||||
| FaxNumber: | 4325174556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2014 | ||||||||
| LastUpdateDate: | 03/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 726445 | TX | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP124695 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 281971602 | 05 | TX | MEDICAID | 726445 | 01 | TX | TEXAS BOARD OF NURSING | OTHER |