Provider Demographics
NPI:1952053043
Name:BASHAM, SHELBI RENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:RENE
Last Name:BASHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHELBI
Other - Middle Name:RENE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 WOODWIND CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-6881
Mailing Address - Country:US
Mailing Address - Phone:502-386-0030
Mailing Address - Fax:
Practice Address - Street 1:2620 ELM HILL PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3108
Practice Address - Country:US
Practice Address - Phone:877-373-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1141289363LF0000X
KY3017368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily