Provider Demographics
NPI:1497015861
Name:CHAMBERLAIN, SHELLEY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:CHAMBERLAIN
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 1:510 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-452-1354
Mailing Address - Fax:615-452-1356
Practice Address - Street 1:510 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-452-1354
Practice Address - Fax:615-452-1356
Is Sole Proprietor?:No
Enumeration Date:2012-05-20
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health