MEDICARE: SHELLY FAY ADKINS RN, BSN, CCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	849735	TX

General Provider Information

NPI Number	:	1912743220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY FAY ADKINS RN, BSN, CCM

Provider Business Mailing Address
First Line	:	1000 VIBURNUM DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-2131
Country	:	US
Telephone Number	:	214-354-2283
Fax Number	:	877-215-5015

Provider Business Practice Location Address
First Line	:	1000 VIBURNUM DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-2131
Country	:	US
Telephone Number	:	214-354-2283
Fax Number	:	877-215-5015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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