Provider Demographics
NPI:1316711856
Name:MIDDLETON, SHANNON (APRN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CHAPMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MUNICIPAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-3703
Mailing Address - Country:US
Mailing Address - Phone:903-713-1574
Mailing Address - Fax:
Practice Address - Street 1:100 MUNICIPAL DR STE 300
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-3703
Practice Address - Country:US
Practice Address - Phone:903-713-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily