Provider Demographics
NPI:1114052701
Name:CONYERS-VOTAW, SHELLI ELAINE
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:ELAINE
Last Name:CONYERS-VOTAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:ELAINE
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:225 SPEARS LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 WALTER REED RD.
Practice Address - Street 2:
Practice Address - City:BURGIN
Practice Address - State:KY
Practice Address - Zip Code:40310
Practice Address - Country:US
Practice Address - Phone:859-239-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3245P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily