Healthcare Provider Details

I. General information

NPI: 1053065524
Provider Name (Legal Business Name): SHELLIE ANN RABNER RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 HIGHLAND VILLAGE RD STE 130
HIGHLAND VILLAGE TX
75077-7189
US

IV. Provider business mailing address

2280 HIGHLAND VILLAGE RD STE 130
HIGHLAND VILLAGE TX
75077-7189
US

V. Phone/Fax

Practice location:
  • Phone: 972-317-1400
  • Fax: 972-317-1477
Mailing address:
  • Phone: 972-317-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1069776
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number777884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: