Healthcare Provider Details

I. General information

NPI: 1235147646
Provider Name (Legal Business Name): SHELYNA A THAWER-RICE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELYNA A THAWER

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 10TH ST
ARCATA CA
95521-6210
US

IV. Provider business mailing address

3992 LORD BYRON CIR
ROUND ROCK TX
78664-3935
US

V. Phone/Fax

Practice location:
  • Phone: 707-826-8610
  • Fax:
Mailing address:
  • Phone: 318-436-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201700411NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number837041
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: