Provider Demographics
NPI:1902237936
Name:KELEHAN, SHANE L (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:L
Last Name:KELEHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N ALAMO BLVD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-3451
Mailing Address - Country:US
Mailing Address - Phone:903-927-2824
Mailing Address - Fax:903-927-2880
Practice Address - Street 1:300 N ALAMO BLVD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-3451
Practice Address - Country:US
Practice Address - Phone:903-927-2824
Practice Address - Fax:903-927-2880
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08691363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical