Provider Demographics
NPI:1851193478
Name:VAN SICKLER, SHELBY (FNP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:VAN SICKLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAISSON TRCE
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3101
Mailing Address - Country:US
Mailing Address - Phone:251-753-1680
Mailing Address - Fax:
Practice Address - Street 1:9 CAISSON TRCE
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-3101
Practice Address - Country:US
Practice Address - Phone:251-753-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-181398163W00000X
ALF01250218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse