Provider Demographics
NPI:1538344064
Name:SHELBY, PEGGY HILL (FNP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:HILL
Last Name:SHELBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 OLD RICHBURG RD
Mailing Address - Street 2:P O BOX 414
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-7801
Mailing Address - Country:US
Mailing Address - Phone:601-794-5045
Mailing Address - Fax:
Practice Address - Street 1:6440 SOUTH MILLROCK DR SUITE 175
Practice Address - Street 2:COMP HEALTH
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84171
Practice Address - Country:US
Practice Address - Phone:800-634-9583
Practice Address - Fax:866-588-1339
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR727296363LF0000X
AZAP3282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCG7880OtherMEDICARE RAILROAD
AZ411368Medicaid
MS05851267Medicaid
AZ033987Medicare Oscar/Certification
AZZP03006701Medicare PIN
AZCG7880OtherMEDICARE RAILROAD
AZ033994Medicare Oscar/Certification
MS512I500259Medicare PIN