Provider Demographics
NPI:1497273171
Name:WRAY, SHELLY (APRN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1628 LOCKNEY ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2408
Mailing Address - Country:US
Mailing Address - Phone:806-654-3421
Mailing Address - Fax:
Practice Address - Street 1:1524 GUY LANE PLZ
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-5542
Practice Address - Country:US
Practice Address - Phone:806-948-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily