Healthcare Provider Details

I. General information

NPI: 1205765427
Provider Name (Legal Business Name): MISS SHELLYE NICOLE NEVILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MEDICAL CENTER BLVD
WEBSTER TX
77598-4220
US

IV. Provider business mailing address

17807 WAKE CT
CROSBY TX
77532-4143
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-2511
  • Fax:
Mailing address:
  • Phone: 832-572-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number905790
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: