Provider Demographics
NPI:1083497416
Name:BLICKENSTAFF, SHELBY (MS, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:
Last Name:BLICKENSTAFF
Suffix:
Gender:F
Credentials:MS, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6571 W 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-3115
Mailing Address - Country:US
Mailing Address - Phone:720-955-6901
Mailing Address - Fax:
Practice Address - Street 1:1260 S PARKER RD STE 201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-8068
Practice Address - Country:US
Practice Address - Phone:303-522-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COF05231105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily