Provider Demographics
NPI:1356968762
Name:PRICHARD, SHELLY (NP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:PRICHARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 BARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-5654
Mailing Address - Country:US
Mailing Address - Phone:574-549-4460
Mailing Address - Fax:
Practice Address - Street 1:605 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1857
Practice Address - Country:US
Practice Address - Phone:260-982-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28123343A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine