Provider Demographics
NPI:1821226218
Name:JELINEK, SHELLEY (CRNA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:JELINEK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BENT CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2172
Mailing Address - Country:US
Mailing Address - Phone:731-668-1853
Mailing Address - Fax:731-664-7731
Practice Address - Street 1:620 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3923
Practice Address - Country:US
Practice Address - Phone:731-668-1853
Practice Address - Fax:731-664-7731
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN148114163W00000X
TN14355367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN148114OtherRN LICENSE
TN14355OtherAPN LICENSE