Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane Kelleher, PA-C

Individual provider Physician Assistant · NPI 1003273939

Shane Kelleher, PA-C is a Physician Assistant in Fort Worth, Texas. Licensed in Oklahoma and Texas. Registered with an NPI since 2016.

Licensed in
OK, TX
In the registry since
2016
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1500 Cooper St
Fort Worth, TX 76104-2710
Phone: (682) 885-7840
Fax: (682) 885-7856
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA105592 (TX)
Physician Assistant Taxonomy 363A00000X · Licence 2628 (OK)

Record details

NPI number1003273939
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 22, 2016
Last updated in NPPESAugust 2, 2016
Mailing addressPo Box 99371, Fort Worth, TX 76199-0371

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