Provider Demographics
NPI:1104299155
Name:PERRYMAN, SHANNON (NP-C)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 BLUFFSIDE LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:902 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2515
Practice Address - Country:US
Practice Address - Phone:512-229-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily