Provider Demographics
NPI:1790207702
Name:CREIGHTON, SHELLEY (CNM)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 5208
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5208
Mailing Address - Country:US
Mailing Address - Phone:601-486-4210
Mailing Address - Fax:
Practice Address - Street 1:1020 22ND AVE STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5001
Practice Address - Country:US
Practice Address - Phone:601-703-1003
Practice Address - Fax:601-703-0124
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23188367A00000X
MS899572176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife