Provider Demographics
NPI:1548077472
Name:COOPER, SHELBY C (APRN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:C
Last Name:COOPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:CHRISTINE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:884 E 1250 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9125
Mailing Address - Country:US
Mailing Address - Phone:801-796-2236
Mailing Address - Fax:
Practice Address - Street 1:884 E 1250 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-9125
Practice Address - Country:US
Practice Address - Phone:801-796-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11995185-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty