Healthcare Provider Details

I. General information

NPI: 1336874031
Provider Name (Legal Business Name): SHELBY L RILEY APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 ANDREWS HWY # 300
MIDLAND TX
79703-5132
US

IV. Provider business mailing address

3403 ANDREWS HWY # 300
MIDLAND TX
79703-5132
US

V. Phone/Fax

Practice location:
  • Phone: 432-522-1234
  • Fax:
Mailing address:
  • Phone: 542-522-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1086324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: