Provider Demographics
NPI:1528373362
Name:BREWSTER, SHELLY (APRN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:GUILLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1905 ELDER HILL RD
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-2125
Mailing Address - Country:US
Mailing Address - Phone:512-324-6767
Mailing Address - Fax:
Practice Address - Street 1:1905 ELDER HILL RD
Practice Address - Street 2:
Practice Address - City:DRIFTWOOD
Practice Address - State:TX
Practice Address - Zip Code:78619-2102
Practice Address - Country:US
Practice Address - Phone:512-324-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X, 3245S0500X
TXAP129246363LF0000X
UT4963175-3102163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)