Healthcare Provider Details

I. General information

NPI: 1518330018
Provider Name (Legal Business Name): ASHLEY SHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MCGAHA

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 22ND ST
LUBBOCK TX
79410
US

IV. Provider business mailing address

3419 22ND ST
LUBBOCK TX
79410-1334
US

V. Phone/Fax

Practice location:
  • Phone: 806-796-3000
  • Fax: 806-796-3006
Mailing address:
  • Phone: 806-796-3000
  • Fax: 806-796-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129317
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: