Healthcare Provider Details

I. General information

NPI: 1992502918
Provider Name (Legal Business Name): SHELBY KNOX CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 1ST ST
WELLSBURG IA
50680-7700
US

IV. Provider business mailing address

PO BOX 71
WELLSBURG IA
50680-0071
US

V. Phone/Fax

Practice location:
  • Phone: 319-464-4670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: