Provider Demographics
NPI:1508301235
Name:BELVIN, SHELLEY HENSON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:HENSON
Last Name:BELVIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 HARRISON ST
Mailing Address - Street 2:PARK MEDICAL I, SUITE 301
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1154
Mailing Address - Country:US
Mailing Address - Phone:409-923-1650
Mailing Address - Fax:
Practice Address - Street 1:950 N 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1112
Practice Address - Country:US
Practice Address - Phone:409-833-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387280601Medicaid