Provider Demographics
NPI:1417841610
Name:SHELNUTT, KEELY-ANN
Entity type:Individual
Prefix:
First Name:KEELY-ANN
Middle Name:
Last Name:SHELNUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 GATEWAY STE F-702
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-1196
Mailing Address - Country:US
Mailing Address - Phone:325-530-4089
Mailing Address - Fax:
Practice Address - Street 1:749 GATEWAY STE F-702
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1196
Practice Address - Country:US
Practice Address - Phone:325-530-4089
Practice Address - Fax:866-373-8243
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician