Individual
MR. SHELBY RIGDON TIEKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-1100
Mailing address
200 W MAGNOLIA AVE STE 201, FT WORTH, TX 76104-7657
(817) 702-2977
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1028643
TX
Other
Enumeration date
02/12/2021
Last updated
01/10/2024
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