Provider Demographics
NPI:1396330478
Name:THOMAS, SHELLY (PMHNP-BC, APRN, RN)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PMHNP-BC, APRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 PRESIDIO CIR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-5722
Mailing Address - Country:US
Mailing Address - Phone:817-946-9053
Mailing Address - Fax:
Practice Address - Street 1:2107 PRESIDIO CIR
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-5722
Practice Address - Country:US
Practice Address - Phone:817-946-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031013363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health