Provider Demographics
NPI:1720617699
Name:CRAIG, SHELLI RENEE
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:RENEE
Last Name:CRAIG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-3105
Mailing Address - Country:US
Mailing Address - Phone:940-264-8818
Mailing Address - Fax:940-264-8819
Practice Address - Street 1:1410 8TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3105
Practice Address - Country:US
Practice Address - Phone:940-264-8818
Practice Address - Fax:940-264-8819
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner