Provider Demographics
NPI:1164750923
Name:DAMSCHRODER, SHELLY BETHANN (NP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:BETHANN
Last Name:DAMSCHRODER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:6648 N VIEWPOINT DR STE 5
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-4942
Practice Address - Country:US
Practice Address - Phone:928-708-4800
Practice Address - Fax:928-458-2123
Is Sole Proprietor?:No
Enumeration Date:2009-12-05
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily