Provider Demographics
NPI:1225353584
Name:ELAM, SHELLY LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:ELAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 POINT WEST PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124
Mailing Address - Country:US
Mailing Address - Phone:806-418-8620
Mailing Address - Fax:806-418-8626
Practice Address - Street 1:1805 POINT WEST PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124
Practice Address - Country:US
Practice Address - Phone:806-418-8620
Practice Address - Fax:806-418-8626
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX588845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily