MEDICARE: SHELBY SMITH BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1-181971	AL
2	367500000X	Certified Registered Nurse Anesthetist	1-181871	AL

General Provider Information

NPI Number	:	1730922949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY SMITH BSN

Provider Business Mailing Address
First Line	:	1620 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-5408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-5408
Country	:	US
Telephone Number	:	615-653-0878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2024
Last Update Date	:	04/07/2026

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Directions to “ SHELBY SMITH BSN” Practice Location

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