MEDICARE: SHELLY BISHARD PMHNP

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	AP145840	TX

General Provider Information

NPI Number	:	1750900130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY BISHARD PMHNP

Provider Business Mailing Address
First Line	:	84 PARKER RD
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495-4333
Country	:	US
Telephone Number	:	214-491-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 HEBRON PKWY STE 1101
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-5147
Country	:	US
Telephone Number	:	469-444-2244
Fax Number	:

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	03/24/2025

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