Provider Demographics
NPI:1831847524
Name:CAMPBELL, SHELLY ANN (APRN)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MEDICAL PLAZA DR STE 280
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3209
Mailing Address - Country:US
Mailing Address - Phone:281-363-4445
Mailing Address - Fax:
Practice Address - Street 1:1001 MEDICAL PLAZA DR STE 280
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3209
Practice Address - Country:US
Practice Address - Phone:281-363-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily