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Individual
SHANNON HERRICK
Active
Individual
SHANNON HERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L6939
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163596302
—
TX
05
—
163596303
—
TX
05
—
200067740A
—
OK
05
—
59271086
—
NM
Enumeration date
07/07/2006
Last updated
06/02/2016
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