Provider Demographics
NPI:1235147646
Name:THAWER-RICE, SHELYNA A (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:SHELYNA
Middle Name:A
Last Name:THAWER-RICE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHELYNA
Other - Middle Name:A
Other - Last Name:THAWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3992 LORD BYRON CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3935
Mailing Address - Country:US
Mailing Address - Phone:318-436-9991
Mailing Address - Fax:
Practice Address - Street 1:770 10TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6210
Practice Address - Country:US
Practice Address - Phone:707-826-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX837041363LP2300X
OR201700411NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1557374Medicaid
LA5X959Medicare ID - Type Unspecified
LA1557374Medicaid