Provider Demographics
NPI:1134459449
Name:NOE, SHELLY RAE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RAE
Last Name:NOE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10614 N VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6027
Mailing Address - Country:US
Mailing Address - Phone:575-639-0444
Mailing Address - Fax:
Practice Address - Street 1:2211 N MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1136
Practice Address - Country:US
Practice Address - Phone:575-639-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01583363LP0808X
NM01583363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24206229Medicaid