Provider Demographics
NPI:1699064410
Name:OWEN, SHELLY WILLES (PA-C)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:WILLES
Last Name:OWEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:R
Other - Last Name:WILLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2434
Mailing Address - Country:US
Mailing Address - Phone:307-358-7300
Mailing Address - Fax:
Practice Address - Street 1:2820 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8624
Practice Address - Country:US
Practice Address - Phone:406-252-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant