Provider Demographics
NPI:1598723397
Name:SPEED, SHELLEY MARIE (RN, ACNP-C)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:MARIE
Last Name:SPEED
Suffix:
Gender:F
Credentials:RN, ACNP-C
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:MARIE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ACNP-C
Mailing Address - Street 1:1310 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-7725
Mailing Address - Country:US
Mailing Address - Phone:214-330-0402
Mailing Address - Fax:
Practice Address - Street 1:1310 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-7725
Practice Address - Country:US
Practice Address - Phone:214-384-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX592021363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care