Healthcare Provider Details

I. General information

NPI: 1578208559
Provider Name (Legal Business Name): SHELBI CHEATHAM FISHER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3926
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 270-858-4029
Mailing address:
  • Phone: 270-864-1472
  • Fax: 270-864-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016681
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: