Provider Demographics
NPI:1629817879
Name:SHELLEY, BARBARA ANN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:
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 672
Mailing Address - Street 2:
Mailing Address - City:CAPON BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711-0672
Mailing Address - Country:US
Mailing Address - Phone:504-327-1924
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 192
Practice Address - Street 2:
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711-0192
Practice Address - Country:US
Practice Address - Phone:304-856-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant