Active NPI
Shannon Wilson Graham, RN,CNS
- Psychiatric/Mental Health Clinical Nurse Specialist
- Del Rio, TX
National Provider Identifier
1649490665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Clinical Nurse Specialist
- License
- 504390
- Practice address
- 400 Quail Creek Dr
Del Rio, TX 78840-2133 - Phone
- (830) 778-1509
- Fax
- (830) 778-1509
- NPI assigned
- May 1, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0808X | 504390 | TX | Primary |
Addresses
Primary practice location
400 Quail Creek Dr
Del Rio, TX 78840-2133
Mailing address
400 Quail Creek Dr
Del Rio, TX 78840-2133
Phone (830) 778-1509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Specialist, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 504390 | TX | MD | Psychiatric/Mental Health Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649490665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 QUAIL CREEK DR",
"city": "DEL RIO",
"state": "TX",
"postal_code": "788402133",
"telephone_number": "830-778-1509",
"fax_number": "830-778-1509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 QUAIL CREEK DR",
"city": "DEL RIO",
"state": "TX",
"postal_code": "788402133",
"telephone_number": "830-778-1509",
"fax_number": "830-778-1509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "SHANNON",
"middle_name": "WILSON",
"credential": "RN,CNS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "364SP0808X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
"state": "TX",
"license": "504390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Del Rio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.