Provider Demographics
NPI:1346307634
Name:LEITCH, SHELLY M (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:M
Last Name:LEITCH
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-9231
Mailing Address - Country:US
Mailing Address - Phone:281-538-2722
Mailing Address - Fax:
Practice Address - Street 1:416 HIGHWAY 87
Practice Address - Street 2:TEEN HEALTH CENTER, INC.-CRENSHAW
Practice Address - City:CRYSTAL BEACH
Practice Address - State:TX
Practice Address - Zip Code:77650
Practice Address - Country:US
Practice Address - Phone:409-766-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX453991363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics