Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP136916 | TX |
NPI | 1003313552 |
---|---|
Provider Name | Shannon L Mckeown |
First Address | Denton, TX 76205-4503 |
Second Address | Denton, TX 76205-4503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 11/04/2018 |