Provider Demographics
NPI:1902675218
Name:DUFFEY, SHELBY (AGACNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:DUFFEY
Suffix:
Gender:F
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S PURCELL BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5123
Mailing Address - Country:US
Mailing Address - Phone:719-281-9587
Mailing Address - Fax:
Practice Address - Street 1:141 S PURCELL BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5123
Practice Address - Country:US
Practice Address - Phone:719-281-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1652086163WM0705X
CO0999487-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical