Shannan Lea Smith, MSN, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1168185 Issued in TX

Practice address

560 N Kimball Ave Ste 130
Southlake, TX 76092-6879

Phone

(817) 899-8485

NPI assigned

Jul 8, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shannan Lea Willman-Needleman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1386480473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 N KIMBALL AVE STE 130",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926879",
            "telephone_number": "817-899-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 N KIMBALL AVE STE 130",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926879",
            "telephone_number": "817-899-8485"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "719 Love Henry Ct",
            "address_purpose": "LOCATION",
            "city": "Southlake",
            "state": "TX",
            "postal_code": "760926067",
            "country_code": "US",
            "telephone_number": "817-456-5065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANNAN",
        "middle_name": "LEA",
        "credential": "MSN, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1168185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNAN",
            "last_name": "WILLMAN-NEEDLEMAN",
            "middle_name": "LEA",
            "credential": "BSN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey A Smith, M.D.
• Julie E. Smith, LPC-A
• Linda Pearl Smith, LPC-INTERN
• McKenzie T Smith
• Rayna L Smith, PA-C
• Tracee Smith, MPT, DPT
• Monica Kaye Ortlieb Smothers, M.A., CCC-SLP
• Sohn Dental, PC
• Solar Health, P.a.
• Luke Paine Sorrell, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Southlake, TX
• Providers in Southlake, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.