Provider Demographics
NPI:1821563016
Name:CASPER, SHELBY MALIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MALIN
Last Name:CASPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32770 COUNTY ROAD 17
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-9464
Mailing Address - Country:US
Mailing Address - Phone:719-688-9962
Mailing Address - Fax:
Practice Address - Street 1:403 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3953
Practice Address - Country:US
Practice Address - Phone:719-336-6767
Practice Address - Fax:719-336-7217
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994194-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily