Provider Demographics
NPI:1396389870
Name:WILLIAMS, SHELLY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13219 COUNTY ROAD 285
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-6644
Mailing Address - Country:US
Mailing Address - Phone:903-780-5032
Mailing Address - Fax:
Practice Address - Street 1:1420 W SOUTHWEST LOOP 323 STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9347
Practice Address - Country:US
Practice Address - Phone:903-534-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine