MR. SHELBY ODELL CHURCH JR. (NPI# 1942365564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942365564 |
| Entity Type | Individual |
| Full Name | MR. SHELBY ODELL CHURCH JR. |
| Credential | PA-C |
| Practice Address |
6450 Folsom Dr Beaumont Family Practice Associates Beaumont TX 77706-7269 |
| Mailing Address |
200 Hendricks Dr Silsbee TX 77656-6310 |
| Practice Telephone | 4098350524 |
| Practice Fax Number | 4098332058 |
| Mailing Telephone | 4093861046 |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2010-09-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA01919 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6450 FOLSOM DR BEAUMONT FAMILY PRACTICE ASSOCIATES |
| City | BEAUMONT |
| State | TX |
| Zip Code | 77706-7269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538160726 | Jay C. Proctor IIi | Family Medicine | 6450 Folsom Dr, Beaumont, TX 77706-7269 | 2005-08-10 |
| 1184132532 | Aaran Michelle Gassiott | Nurse Practitioner | 6450 Folsom Dr, Beaumont, TX 77706-7269 | 2018-01-19 |
| 1306209721 | Waylon Casey Bergeron | Nurse Practitioner | 6450 Folsom Dr, Beaumont, TX 77706-7269 | 2016-04-02 |
| 1760782635 | Nighthawk Physicians of Texas, Pa | Radiology | 6450 Folsom Dr, Beaumont, TX 77706-7269 | 2010-10-26 |
| 1114059516 | Valerie Johnson | Physician Assistant | 6450 Folsom Dr, Beaumont, TX 77706-7269 | 2007-03-12 |
| 1003828575 | Kelly Lock | Physician Assistant | 6450 Folsom Dr, Beaumont, TX 77706-7269 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982176293 | Allen Family Home Care LLC | In Home Supportive Care | 4055 Dowlen Rd Ste 112, Beaumont, TX 77706 | 2018-12-27 |
| 1730661174 | Joseph Pryor Ingram | Counselor | 5450 Folsom Road #3, Beaumont, TX 77706 | 2018-09-02 |
| 1336644582 | Jenny Lee Broaddus | Counselor | 8150 N. Major Dr., Beaumont, TX 77706 | 2018-03-29 |
| 1528584026 | Amanthia Peace Williams | Pedorthist | 3645 Calder Ave., Beaumont, TX 77706 | 2017-08-16 |
| 1356863286 | Nicole Denise Williams | Speech-Language Pathologist | 970 North 23rd Street, Beaumont, TX 77706 | 2017-07-12 |
| 1487038923 | Associates for Dental Health, Pllc | Dentist | 415 Dowlen Rd Ste A, Beaumont, TX 77706 | 2015-07-15 |
| 1508264532 | Rose Anne Essex | Dietitian, Registered | 3510 Charleston Ln, Beaumont, TX 77706 | 2014-12-08 |
| 1780001933 | C. Asteris, Inc. | Contractor | 1465 W. Lucas Dr., Beaumont, TX 77706 | 2014-03-26 |
| 1376985820 | Erica J Hayes M D P A | Preferred Provider Organization | 4a Bayou Brandt Drive, Beaumont, TX 77706 | 2013-07-25 |
| 1194162909 | Hezron Omanga | Pharmacist | 3585 N. Dowlen Road, Beaumont, TX 77706 | 2013-06-03 |
| Find all providers in zip 77706 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376012021 | Natalie Anne Polizopoulos-wilson | Physician Assistant | 4215 N Major Dr Apt 1712, Beaumont, TX 77713-9713 | 2018-11-23 |
| 1679625149 | Jane Leskin Walston | Physician Assistant | 3420 Veterans Circle, Beaumont, TX 77707 | 2007-01-17 |
| 1053379768 | Lui Kong Yap | Physician Assistant | 81 Highland Springs Ave, Ste.200, Beaumont, CA 92223 | 2006-05-02 |
| 1336493055 | Brendan Andrew Dunlap | Physician Assistant | 3060 Fm 3514, Beaumont, TX 77705-7635 | 2012-11-02 |
| 1972833085 | Audrey Helen Reyenga | Physician Assistant | 3650 Laurel St, Beaumont, TX 77707-2216 | 2010-01-12 |
| 1497966949 | Jefferson Emergency Medicine Associates Pa | Physician Assistant | 2830 Calder St, Beaumont, TX 77702-1809 | 2007-05-25 |
| 1093852048 | Katherine Demeritt | Physician Assistant | 3080 College St, Beaumont, TX 77701-4606 | 2007-01-31 |
| 1508884362 | Mary Elizabeth Ryan | Physician Assistant | 3420 Veterans Cir, Beaumont, TX 77707-2552 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831704576 | Leila Olive Adell | Physician Assistant | 1221 S Congress Ave Apt 331, Austin, TX 78704-2461 | 2020-09-10 |
| 1619591864 | Today Telemedicine Pllc | Physician Assistant | 404 Oxford St Apt 2219, Houston, TX 77007-2679 | 2020-06-03 |
| 1497384168 | Gregory C Etienne | Physician Assistant | 7400 N 4th St, Mcallen, TX 78504-1859 | 2020-04-05 |
| 1689202475 | Theodore Inthaphom | Physician Assistant | 25222 Northwest Fwy Apt 349, Cypress, TX 77429-1065 | 2020-03-29 |
| 1740816982 | Alyssa Conrad | Physician Assistant | 4818 Star Jasmine Dr, Austin, TX 78723-6059 | 2020-03-19 |
| 1114558335 | Erin Lynn Brown | Physician Assistant | 1504 Taub Loop Houston, Houston, TX 77030 | 2020-01-27 |
| 1245870930 | Jessica Grimaldo | Physician Assistant | 1200 Brooklyn Ave Ste 230, San Antonio, TX 78212-0010 | 2020-01-09 |
| 1730728528 | Holli Marie Beard | Physician Assistant | 2625 Scripture St Ste 101, Denton, TX 76201-2304 | 2019-12-27 |
| 1477191237 | Ronald Edwin Brown | Physician Assistant | 1427 Cypress Point Dr, Gunter, TX 75058-3201 | 2019-12-11 |
| 1053957910 | Rossalya Aracely Granda Gutierrez | Physician Assistant | 4150 N Collins St, Arlington, TX 76005-4547 | 2019-11-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.