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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

SHADY OAKS CLINIC PLLC
NPI 1245153493
Nurse Practitioner - Family in Runaway Bay, TX

Active since August 04, 2026
204 SHADY OAKS DR, RUNAWAY BAY, TX 76426(940) 239-5550 Get Directions Write a Review

NPPES record added: August 4, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shady Oaks Clinic Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY OAKS CLINIC PLLC (NPI 1245153493) is a healthcare organization registered as a family in Runaway Bay, Texas and active in the NPI registry since August 2026. The organization lists Madison Wellman, Member, as its authorized official.

NPPES Registry Identity

NPI1245153493
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameSHADY OAKS CLINIC PLLC
Location Address204 SHADY OAKS DRRunaway Bay, TX 76426-9462
Mailing Address204 Shady Oaks DrRunaway Bay, TX 76426-9462
Phone(940) 239-5550
Organization SubpartNo
Authorized OfficialMadison WellmanMember · (940) 239-5550
Enumeration DateAugust 4, 2026
NPPES CertifiedAugust 4, 2026
✔ NPI 1245153493 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
204 SHADY OAKS DR, Runaway Bay, TX 76426
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shady Oaks Clinic PLLC's NPI number?

The NPI number for Shady Oaks Clinic PLLC is 1245153493. It was assigned to this organization in the NPPES registry on August 4, 2026.

Where is Shady Oaks Clinic PLLC located?

Shady Oaks Clinic PLLC is located at 204 Shady Oaks Dr, Runaway Bay, TX 76426. The listed phone number is (940) 239-5550.

What is Shady Oaks Clinic PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Shady Oaks Clinic PLLC was last updated on August 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.