Provider Demographics
NPI:1245306026
Name:SHELBY, DEBRA MICHELLE (PHD, DNP, ARNP)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:MICHELLE
Last Name:SHELBY
Suffix:
Gender:F
Credentials:PHD, DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LA ORILLA RD NW STE D3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2742
Mailing Address - Country:US
Mailing Address - Phone:772-708-6776
Mailing Address - Fax:877-335-6410
Practice Address - Street 1:3200 LA ORILLA RD NW STE D3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2742
Practice Address - Country:US
Practice Address - Phone:772-708-6776
Practice Address - Fax:877-335-6410
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2218012363LF0000X
NMCNP03118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00135877OtherRR MEDICARE
FLP24137Medicare UPIN
FLY9404YMedicare PIN