Healthcare Provider Details

I. General information

NPI: 1346823291
Provider Name (Legal Business Name): SHELBY JESSICA FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GRAND AVE
SAN LUIS OBISPO CA
93401-2639
US

IV. Provider business mailing address

705 GRAND AVE
SAN LUIS OBISPO CA
93401-2639
US

V. Phone/Fax

Practice location:
  • Phone: 805-544-2478
  • Fax: 805-787-0725
Mailing address:
  • Phone: 805-544-2478
  • Fax: 805-787-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA213734
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: