Provider Demographics
NPI:1639284581
Name:HOUSE, SHELBY CHRISTINA MARGARET (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHELBY CHRISTINA
Middle Name:MARGARET
Last Name:HOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:CHRISTINA
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-847-3898
Mailing Address - Fax:
Practice Address - Street 1:1201 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9811
Practice Address - Country:US
Practice Address - Phone:270-417-4700
Practice Address - Fax:270-417-4709
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08278363A00000X
KYPA950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000693053OtherANTHEM - NCVA
KY7100172580Medicaid
KY000000557897OtherANTHEM BLUE CROSS BLUE SHIELD
KY000057080TOtherHUMANA - NCVA
KY50033948OtherPASSPORT & PASSPORT ADVTG
KYP400032392Medicare PIN
KY000057080TOtherHUMANA - NCVA
KYQ72090Medicare UPIN