Individual
MRS. SHANNON BALLARD CALLAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 W COUNTRY CLUB RD STE 130, ROSWELL, NM 88201-5249
(575) 625-2669
(575) 624-4632
Mailing address
300 W COUNTRY CLUB RD STE 130, ROSWELL, NM 88201-5249
(575) 625-2669
(575) 624-4632
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
COO2607
MD
363AM0700X
Medical Physician Assistant
Primary
PA2022-0043
NM
Other
Enumeration date
06/09/2005
Last updated
11/05/2024
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