Provider Demographics
NPI:1629866454
Name:ORTIZ, SHELBY KAYE (RN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:KAYE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-2000
Mailing Address - Country:US
Mailing Address - Phone:870-455-6322
Mailing Address - Fax:
Practice Address - Street 1:820 SCHAAL RD
Practice Address - Street 2:
Practice Address - City:MINERAL SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71851-9024
Practice Address - Country:US
Practice Address - Phone:870-703-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR101650163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice