Provider Demographics
NPI:1366983504
Name:TRACY, SHELLI D (FNP)
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:D
Last Name:TRACY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:D
Other - Last Name:NOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 840020
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0020
Mailing Address - Country:US
Mailing Address - Phone:806-358-0200
Mailing Address - Fax:806-356-5590
Practice Address - Street 1:6700 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1701
Practice Address - Country:US
Practice Address - Phone:806-358-0200
Practice Address - Fax:806-356-5590
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133519363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1R0964OtherMEDICARE
TX369856502Medicaid