Healthcare Provider Details

I. General information

NPI: 1437880499
Provider Name (Legal Business Name): SHELBY ELIZABETH CARMICHAEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BLACKBURN LN
DRY RIDGE KY
41035-8806
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-823-5441
  • Fax: 859-823-5001
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05984
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: