Provider Demographics
NPI:1073036786
Name:DUCKETT, SHELBY (DNP, APRN, FNP-BECAU)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BECAU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 NATCHEZ TRACE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7947
Mailing Address - Country:US
Mailing Address - Phone:270-745-7246
Mailing Address - Fax:270-282-2027
Practice Address - Street 1:165 NATCHEZ TRACE AVE STE 205
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7947
Practice Address - Country:US
Practice Address - Phone:270-745-7246
Practice Address - Fax:270-282-2027
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22813363LF0000X
KY3016609363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily