Individual provider · Type 1 NPI
Shannon Blackstock, RN, CPNP
Pediatric Nurse Practitioner · Austin, TX
NPI number
1174801138
Active
Practice location
1301 Barbara Jordan Blvd, Suite 200
Austin, TX 78723-3077
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | 731190 (TX) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1174801138
Shannon Blackstock, RN, CPNP's National Provider Identifier is 1174801138, issued on Jul 25, 2011. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Austin, TX. The record was last updated on Feb 29, 2012.