Provider Demographics
NPI:1073684353
Name:SETH, SHELLY LYNN ANN (CWOCN, FNP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN ANN
Last Name:SETH
Suffix:
Gender:F
Credentials:CWOCN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:SUITE #301
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-355-9741
Practice Address - Fax:806-356-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255623363LF0000X
TXAP111914363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP71734Medicare UPIN
8D9363Medicare ID - Type Unspecified