Healthcare Provider Details

I. General information

NPI: 1295320505
Provider Name (Legal Business Name): SHELBY BAGNALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 TRUXTUN AVE
BAKERSFIELD CA
93301
US

IV. Provider business mailing address

3105 WILSON RD
BAKERSFIELD CA
93304-5319
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-7817
  • Fax:
Mailing address:
  • Phone: 661-397-8775
  • Fax: 661-397-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: