Provider Demographics
NPI:1780961987
Name:HARGROVE, SHELLY MARIE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:MARIE
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 MALONE RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-8729
Mailing Address - Country:US
Mailing Address - Phone:931-638-1463
Mailing Address - Fax:
Practice Address - Street 1:6688 NOLENSVILLE RD STE 108
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8873
Practice Address - Country:US
Practice Address - Phone:706-799-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily