Provider Demographics
NPI:1710323399
Name:FRYE, SHELBY LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LEIGH
Last Name:FRYE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:LEIGH
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:100 GARNET WAY
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59756-9705
Mailing Address - Country:US
Mailing Address - Phone:406-693-7269
Mailing Address - Fax:877-992-5547
Practice Address - Street 1:100 GARNET WAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756-9705
Practice Address - Country:US
Practice Address - Phone:406-693-7000
Practice Address - Fax:406-693-7069
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT44916163W00000X, 363LP0808X
MT100873363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse