Provider Demographics
NPI:1467439422
Name:SOMERS, SHELLY MCCLUNG (CRNP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MCCLUNG
Last Name:SOMERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-1090
Mailing Address - Country:US
Mailing Address - Phone:724-662-4990
Mailing Address - Fax:724-662-2782
Practice Address - Street 1:400 W BUTLER ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-1090
Practice Address - Country:US
Practice Address - Phone:724-662-4990
Practice Address - Fax:724-662-2782
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005608B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS85695Medicare UPIN