Gresham, Shelly Y

Gresham, Shelly Y is an individual health care provider with primary practice located at 2480 Three Rivers Blvd , Poplar Bluff MO 63901-2318. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Gresham, Shelly Y can be contacted via phone (573) 686-5564.

Contact Information

Primary practice address
2480 Three Rivers Blvd Poplar Bluff MO 63901-2318
Phone: (573) 686-5564
Fax: (573) 686-2838
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 126637 Missouri

Profile Details

NPI number 1063491405
LBN Legal business name Gresham, Shelly Y
Credentials RNC-FNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 13th, 2006
Last updated Sep 22nd, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063491405 NPPES
Missouri MEDICAID 428569842

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