Individual
KELLEY SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3220 PARKWOOD BLVD, FRISCO, TX 75034-1917
(972) 668-3990
Mailing address
3220 PARKWOOD BLVD, FRISCO, TX 75034-1917
(972) 668-3990
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA13393
PHYSICIAN ASSISTANT LICENSE
TX
Enumeration date
05/23/2020
Last updated
03/07/2023
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