Provider Demographics
NPI:1851577282
Name:SHELLEY MULLEN HOWELL D.O., PA
Entity Type:Organization
Organization Name:SHELLEY MULLEN HOWELL D.O., PA
Other - Org Name:FAMILY PRACTICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:MULLEN
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-778-2734
Mailing Address - Street 1:1717 SW H K DODGEN LOOP
Mailing Address - Street 2:SUITE 114B
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1838
Mailing Address - Country:US
Mailing Address - Phone:254-778-2734
Mailing Address - Fax:254-778-0616
Practice Address - Street 1:1717 SW H K DODGEN LOOP
Practice Address - Street 2:SUITE 114B
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1838
Practice Address - Country:US
Practice Address - Phone:254-778-2734
Practice Address - Fax:254-778-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3310261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDF4415Medicare PIN
TX00EM61Medicare PIN