Provider Demographics
NPI:1457138976
Name:LADD, SHELBY JANE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:JANE
Last Name:LADD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JANE
Other - Last Name:JOSLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 MARRON DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-4510
Mailing Address - Country:US
Mailing Address - Phone:239-590-5671
Mailing Address - Fax:
Practice Address - Street 1:165 MARRON DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-4510
Practice Address - Country:US
Practice Address - Phone:239-590-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant