Provider Demographics
NPI:1497959969
Name:SHURBET, KELLI NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:NICOLE
Last Name:SHURBET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 17
Mailing Address - Street 2:
Mailing Address - City:FLOYDADA
Mailing Address - State:TX
Mailing Address - Zip Code:79235-9002
Mailing Address - Country:US
Mailing Address - Phone:806-293-1359
Mailing Address - Fax:
Practice Address - Street 1:111 E 10TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7361
Practice Address - Country:US
Practice Address - Phone:806-293-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686939163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator