Provider Demographics
NPI:1114003449
Name:ELDRIDGE, SHELEY BUTLER (RN NPC)
Entity Type:Individual
Prefix:
First Name:SHELEY
Middle Name:BUTLER
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:RN NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FESTUS RD
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-9598
Mailing Address - Country:US
Mailing Address - Phone:910-797-7613
Mailing Address - Fax:910-814-6296
Practice Address - Street 1:307 W CORNELIUS HARNETT BLVD
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9335
Practice Address - Country:US
Practice Address - Phone:910-814-6296
Practice Address - Fax:910-814-4065
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000136Medicaid
NC800135OtherLICENSE
NC7000136Medicaid
2599042Medicare ID - Type UnspecifiedIND #