Provider Demographics
NPI:1710486162
Name:CHARLES, SHYLEBRA LEA (APRN)
Entity Type:Individual
Prefix:
First Name:SHYLEBRA
Middle Name:LEA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHYLEBRA
Other - Middle Name:LEA
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:170 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1605
Mailing Address - Country:US
Mailing Address - Phone:606-422-3397
Mailing Address - Fax:
Practice Address - Street 1:124 DIVISION ST STE 2
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1116
Practice Address - Country:US
Practice Address - Phone:606-422-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily