Provider Demographics
NPI:1811877228
Name:SHELLS, PRAYLAR R
Entity type:Individual
Prefix:
First Name:PRAYLAR
Middle Name:R
Last Name:SHELLS
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 1:930 COUNTY ROAD 600
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:MS
Mailing Address - Zip Code:38868-9239
Mailing Address - Country:US
Mailing Address - Phone:662-419-6369
Mailing Address - Fax:
Practice Address - Street 1:3195 MCCULLOUGH BLVD
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-8311
Practice Address - Country:US
Practice Address - Phone:662-350-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS577389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty