Healthcare Provider Details

I. General information

NPI: 1285190892
Provider Name (Legal Business Name): SHELBY NICOLE WILMES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 W ELK AVE
DUNCAN OK
73533-1562
US

IV. Provider business mailing address

8214 HORSETAIL CT
CONROE TX
77385-1102
US

V. Phone/Fax

Practice location:
  • Phone: 802-529-6005
  • Fax:
Mailing address:
  • Phone: 405-779-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139341
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: