Provider Demographics
NPI:1912606674
Name:WILLINGHAM, SHELBY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-0565
Mailing Address - Country:US
Mailing Address - Phone:830-796-7713
Mailing Address - Fax:830-796-7744
Practice Address - Street 1:1050 TX-16, BANDERA, TX 78003
Practice Address - Street 2:1050 TX-16
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:210-695-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant