Provider Demographics
NPI:1750936142
Name:BAUGH, SHELBY RENE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENE
Last Name:BAUGH
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ESKENAZI AVE.
Mailing Address - Street 2:FIFTH THIRD BANK BUILDING, SECOND FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-880-7069
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE.
Practice Address - Street 2:FIFTH THIRD BANK BUILDING, SECOND FLOOR
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-880-7069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRN-INDIANA-28231867A363LF0000X
IN71009361A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300030784Medicaid