=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538680822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELLY CHRISTINA WILLIAMS FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2017
-----------------------------------------------------
Last Update Date | 07/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5757 FLEWELLEN OAKS LN STE 302
-----------------------------------------------------
City | FULSHEAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77441-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-987-7828
-----------------------------------------------------
Fax | 713-804-9449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5757 FLEWELLEN OAKS LN STE 302
-----------------------------------------------------
City | FULSHEAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77441-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-987-7828
-----------------------------------------------------
Fax | 713-804-9449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP138281
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------