Provider Demographics
NPI:1912743220
Name:ADKINS, SHELLY FAY (RN, BSN, CCM)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:FAY
Last Name:ADKINS
Suffix:
Gender:F
Credentials:RN, BSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VIBURNUM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-2131
Mailing Address - Country:US
Mailing Address - Phone:214-354-2283
Mailing Address - Fax:877-215-5015
Practice Address - Street 1:1000 VIBURNUM DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-2131
Practice Address - Country:US
Practice Address - Phone:214-354-2283
Practice Address - Fax:877-215-5015
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX849735163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management