Provider Demographics
NPI:1093575151
Name:ROBINSON, SHANNETTA (NP)
Entity type:Individual
Prefix:
First Name:SHANNETTA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:1505 LBJ FWY STE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-6065
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6941
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1155423363LF0000X, 363L00000X
TX1155423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1155423OtherLICENSE