Individual
MS. SHELLY MARGARET STATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
1353 N TRAVIS ST, LIBERTY, TX 77575-3549
(832) 397-9283
Mailing address
21542 HAWKSPUR RIDGE ST, RICHMOND, TX 77406-5259
(832) 397-9283
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA02525
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA02525
PHYSICIAN ASSISTANT LICENSE
TX
Enumeration date
01/27/2009
Last updated
11/27/2012
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