Provider Demographics
NPI:1447387758
Name:PAYNTER, SHELLY K (RN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:K
Last Name:PAYNTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:K
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:210 SCOBY AVENUE
Mailing Address - Street 2:PO BOX 509
Mailing Address - City:HIGHMORE
Mailing Address - State:SD
Mailing Address - Zip Code:57345-0509
Mailing Address - Country:US
Mailing Address - Phone:605-852-2138
Mailing Address - Fax:
Practice Address - Street 1:HWY 34 AND 47
Practice Address - Street 2:
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339-0200
Practice Address - Country:US
Practice Address - Phone:605-245-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR025813163WC1500X, 163WM0102X, 163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Not Answered163WP1700XNursing Service ProvidersRegistered NursePerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5549010Medicaid
SDR025813OtherSTATE LICENSE NUMBER