Healthcare Provider Details

I. General information

NPI: 1639284581
Provider Name (Legal Business Name): SHELBY CHRISTINA MARGARET HOUSE P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY CHRISTINA ARCHER P.A.-C.

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 N GARDNER ST
SCOTTSBURG IN
47170-7751
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-2029
  • Fax: 812-752-4654
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08278
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA950
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: