Provider Demographics
NPI:1952122822
Name:POROD, SHELBEY DAWN (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHELBEY
Middle Name:DAWN
Last Name:POROD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHELBEY
Other - Middle Name:DAWN
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:TN
Mailing Address - Zip Code:38222-0071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2982
Practice Address - Country:US
Practice Address - Phone:573-458-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36545363LF0000X
MO2024042778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily