Provider Demographics
NPI:1093827537
Name:ROCK, SHELLY L (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:ROCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LYNN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:21212 NORTHWEST FWY STE 385
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5890
Mailing Address - Country:US
Mailing Address - Phone:713-766-5437
Mailing Address - Fax:
Practice Address - Street 1:21212 NORTHWEST FWY STE 385
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5890
Practice Address - Country:US
Practice Address - Phone:713-766-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA689363A00000X
TX08797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100716660AMedicaid
OK8EZ49TOtherCMS
OK100716660AMedicaid