Provider Demographics
NPI:1104641778
Name:HOPKO, SHELLY LYNN (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:LYNN
Last Name:HOPKO
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MISS
Other - First Name:SHELLY
Other - Middle Name:LYNN
Other - Last Name:BEAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:208 N CHARITY LN
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2366
Mailing Address - Country:US
Mailing Address - Phone:478-662-1382
Mailing Address - Fax:
Practice Address - Street 1:1117 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2905
Practice Address - Country:US
Practice Address - Phone:478-224-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214567163W00000X
GANCO-000008363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse