Provider Demographics
NPI:1316214844
Name:FOUST, SHELLY BURNS (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:BURNS
Last Name:FOUST
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEW YORK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5212
Mailing Address - Country:US
Mailing Address - Phone:865-835-5400
Mailing Address - Fax:865-835-5401
Practice Address - Street 1:200 NEW YORK AVE
Practice Address - Street 2:STE 200
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5212
Practice Address - Country:US
Practice Address - Phone:865-835-5400
Practice Address - Fax:865-835-5401
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16267363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health