Provider Demographics
NPI:1376043158
Name:FARMER, SHELLEY R (RN-BSN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:FARMER
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 BRIGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3803
Mailing Address - Country:US
Mailing Address - Phone:469-955-9264
Mailing Address - Fax:
Practice Address - Street 1:1032 BRIGHAM DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-3803
Practice Address - Country:US
Practice Address - Phone:469-955-9264
Practice Address - Fax:469-955-9264
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX818183163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse