Provider Demographics
NPI:1043980089
Name:MIHALIC, SHELBY KATHERINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:KATHERINE
Last Name:MIHALIC
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:KATHERINE
Other - Last Name:SUPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:10 HALTON GREEN WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6606
Practice Address - Country:US
Practice Address - Phone:864-675-5000
Practice Address - Fax:864-675-5005
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25502363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP8433Medicaid