Provider Demographics
NPI:1073974556
Name:MORELAND, SHELLEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:MORELAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 10TH AVE S
Mailing Address - Street 2:#610
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1605
Mailing Address - Country:US
Mailing Address - Phone:205-933-2691
Mailing Address - Fax:205-933-2350
Practice Address - Street 1:2660 10TH AVE S
Practice Address - Street 2:#610
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1605
Practice Address - Country:US
Practice Address - Phone:205-933-2691
Practice Address - Fax:205-933-2350
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1538255922Medicaid
AL1-111866OtherRN LICENSE NUMBER
AL5465OtherCRNP RX NUMBER