MEDICARE: SHELLY THOMAS PMHNP-BC, APRN, RN.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1031013	TX

General Provider Information

NPI Number	:	1396330478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY THOMAS PMHNP-BC, APRN, RN.

Provider Business Mailing Address
First Line	:	2107 PRESIDIO CIR
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76040-5722
Country	:	US
Telephone Number	:	817-946-9053
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 PRESIDIO CIR
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76040-5722
Country	:	US
Telephone Number	:	817-946-9053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	05/28/2026

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