Provider Demographics
NPI:1740989052
Name:SE MOBILE HOUSE CALLS
Entity type:Organization
Organization Name:SE MOBILE HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:859-954-2119
Mailing Address - Street 1:946 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8603
Mailing Address - Country:US
Mailing Address - Phone:859-954-2119
Mailing Address - Fax:
Practice Address - Street 1:946 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8603
Practice Address - Country:US
Practice Address - Phone:859-954-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100861710Medicaid