Provider Demographics
NPI:1578115044
Name:SHOULTES, RASCHELLE DAVIS (FNP)
Entity Type:Individual
Prefix:
First Name:RASCHELLE
Middle Name:DAVIS
Last Name:SHOULTES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:D
Other - Last Name:SHOULTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATT: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:2825 E MALL DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1954
Practice Address - Country:US
Practice Address - Phone:435-251-0400
Practice Address - Fax:435-251-0401
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT339637-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily