Provider Demographics
NPI:1437502085
Name:HERETH, SHELLY LAUREN (CRNA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LAUREN
Last Name:HERETH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LAUREN
Other - Last Name:STEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:730 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1729
Mailing Address - Country:US
Mailing Address - Phone:423-645-0902
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:SUITE C-235
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-602-8400
Practice Address - Fax:423-602-8401
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN200088163W00000X
TNAPN21838367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse