Provider Demographics
NPI:1003466350
Name:BARTH, SHELLY LYNN
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:BARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 COUNTY ROAD 154
Mailing Address - Street 2:
Mailing Address - City:CARPENTER
Mailing Address - State:WY
Mailing Address - Zip Code:82054-9531
Mailing Address - Country:US
Mailing Address - Phone:307-630-8344
Mailing Address - Fax:
Practice Address - Street 1:831 COUNTY ROAD 154
Practice Address - Street 2:
Practice Address - City:CARPENTER
Practice Address - State:WY
Practice Address - Zip Code:82054-9531
Practice Address - Country:US
Practice Address - Phone:307-630-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator