Provider Demographics
NPI:1821758913
Name:FOLSOM, SHELLEY JO (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:JO
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:JO
Other - Last Name:SEARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2380 E ALEXIS AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4724
Mailing Address - Country:US
Mailing Address - Phone:208-312-3999
Mailing Address - Fax:
Practice Address - Street 1:535 W SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4643
Practice Address - Country:US
Practice Address - Phone:208-529-2019
Practice Address - Fax:208-392-4095
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID70296363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health