Provider Demographics
NPI:1659918936
Name:GIBSON, SHELBY ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELAINE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:ELAINE
Other - Last Name:MCMICKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:540 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-8284
Mailing Address - Country:US
Mailing Address - Phone:870-723-5697
Mailing Address - Fax:870-252-2793
Practice Address - Street 1:507 N CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4316
Practice Address - Country:US
Practice Address - Phone:870-888-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty