Provider Demographics
NPI:1609380856
Name:SHADOW, KAREN ELIZABETH (FNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELIZABETH
Last Name:SHADOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:RIOJAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4301 GARTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3157
Mailing Address - Country:US
Mailing Address - Phone:832-556-6625
Mailing Address - Fax:832-566-6650
Practice Address - Street 1:4301 GARTH RD STE 101
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3157
Practice Address - Country:US
Practice Address - Phone:832-556-6625
Practice Address - Fax:832-556-6650
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX92568OtherUTMB