Provider Demographics
NPI:1205333424
Name:ELDER, SHELBY LANE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LANE
Last Name:ELDER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7381 BEAVER GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-2273
Mailing Address - Country:US
Mailing Address - Phone:229-232-2602
Mailing Address - Fax:912-999-3208
Practice Address - Street 1:505 S CHURCH ST BLDG 4
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1413
Practice Address - Country:US
Practice Address - Phone:229-232-2602
Practice Address - Fax:912-999-3208
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN239452363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health