Provider Demographics
NPI:1912014648
Name:POLK, SHELBY B (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:B
Last Name:POLK
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3113
Mailing Address - Country:US
Mailing Address - Phone:662-207-4913
Mailing Address - Fax:662-939-9924
Practice Address - Street 1:1040 RIVER OAKS DR STE 302
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9575
Practice Address - Country:US
Practice Address - Phone:601-939-9923
Practice Address - Fax:601-939-9924
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08476778Medicaid
MS500001890Medicare ID - Type Unspecified
MS08476778Medicaid