Provider Demographics
NPI:1902034440
Name:PRATER, SHELLEY PRATER
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:PRATER
Last Name:PRATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-8068
Mailing Address - Country:US
Mailing Address - Phone:606-541-1594
Mailing Address - Fax:606-796-6577
Practice Address - Street 1:187 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179-8068
Practice Address - Country:US
Practice Address - Phone:606-541-1594
Practice Address - Fax:606-796-6577
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator