Provider Demographics
NPI:1548492572
Name:SWANSON, CONNIE SHEPHERD (PMHNP/MSN)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:SHEPHERD
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PMHNP/MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6758 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-5938
Mailing Address - Country:US
Mailing Address - Phone:713-649-4860
Mailing Address - Fax:
Practice Address - Street 1:6758 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-5938
Practice Address - Country:US
Practice Address - Phone:713-649-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224525363L00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health