Healthcare Provider Details

I. General information

NPI: 1124986583
Provider Name (Legal Business Name): PEYTON CONN SHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 RIVER OAKS DR
FLOWOOD MS
39232-9553
US

IV. Provider business mailing address

134 CHIPPEWA CIR
JACKSON MS
39211-6513
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-1030
  • Fax:
Mailing address:
  • Phone: 601-214-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number902022
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: