Provider Demographics
NPI:1497581102
Name:ROBERSON, SHANA RENAY (RN BSN)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RENAY
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CLAY RD
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-0952
Mailing Address - Country:US
Mailing Address - Phone:325-242-0631
Mailing Address - Fax:
Practice Address - Street 1:210 CLAY RD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-0952
Practice Address - Country:US
Practice Address - Phone:325-242-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX779330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine