Provider Demographics
NPI:1245256262
Name:HUCKABY, SHELLY L (RN, FNP)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:L
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18230 FM 1488 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4530
Mailing Address - Country:US
Mailing Address - Phone:936-270-4800
Mailing Address - Fax:936-270-4801
Practice Address - Street 1:18230 FM 1488 RD STE 200
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4530
Practice Address - Country:US
Practice Address - Phone:936-270-4800
Practice Address - Fax:936-270-4801
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669836363LF0000X
TXAP114965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328218809Medicaid