Provider Demographics
NPI:1588039036
Name:SMITH, SHELLEY ANN (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-0297
Mailing Address - Country:US
Mailing Address - Phone:252-357-1226
Mailing Address - Fax:252-357-1236
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938-9424
Practice Address - Country:US
Practice Address - Phone:252-357-1226
Practice Address - Fax:252-357-1236
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140666363LF0000X
NCMS5229895363LF0000X
MECPN191034363LF0000X
COC-APN.0001453-C-NP363LF0000X
NC5008216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily