MEDICARE: SHELBY K KELLY AGACNP-BC

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	363LC0200X	Critical Care Medicine Nurse Practitioner	1216524	TX

General Provider Information

NPI Number	:	1821966813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY K KELLY AGACNP-BC

Provider Business Mailing Address
First Line	:	15080 FANNIN RD
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3790
Country	:	US
Telephone Number	:	936-217-0899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 ROBINSON CREEK PKWY STE 300
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-2781
Country	:	US
Telephone Number	:	936-439-4835
Fax Number	:	936-439-4837

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

Provider Enumeration Date	:	10/29/2025
Last Update Date	:	01/09/2026

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