Provider Demographics
NPI:1083163380
Name:WILCOX, SHELBY L (AGACNP-BC, MSN)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:L
Last Name:WILCOX
Suffix:
Gender:F
Credentials:AGACNP-BC, MSN
Other - Prefix:MISS
Other - First Name:SHELBY
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC, MSN
Mailing Address - Street 1:418A KALAMA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2096
Mailing Address - Country:US
Mailing Address - Phone:615-772-3996
Mailing Address - Fax:
Practice Address - Street 1:98-1079 MOANALUA RD STE 300
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4722
Practice Address - Country:US
Practice Address - Phone:808-485-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1042752363LA2100X
HIAPRN-2386363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care