Provider Demographics
NPI:1225909559
Name:GANNON, SHANNON A (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:A
Last Name:GANNON
Suffix:
Gender:X
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 135TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2096
Mailing Address - Country:US
Mailing Address - Phone:970-218-9857
Mailing Address - Fax:
Practice Address - Street 1:2920 135TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2096
Practice Address - Country:US
Practice Address - Phone:970-218-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily