Healthcare Provider Details

I. General information

NPI: 1588146039
Provider Name (Legal Business Name): SHELLEY PADGETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SUNSET DR
ANNISTON AL
36207-7607
US

IV. Provider business mailing address

5 SUNSET DR
ANNISTON AL
36207-7607
US

V. Phone/Fax

Practice location:
  • Phone: 332-296-4649
  • Fax: 332-296-7418
Mailing address:
  • Phone: 332-296-4649
  • Fax: 332-296-7418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402964-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: