Provider Demographics
NPI:1356214126
Name:SHELBY, GRACIE ALAINE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:GRACIE
Middle Name:ALAINE
Last Name:SHELBY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22642-6211
Mailing Address - Country:US
Mailing Address - Phone:304-886-4098
Mailing Address - Fax:
Practice Address - Street 1:4400 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4444
Practice Address - Country:US
Practice Address - Phone:703-993-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024194770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily