Healthcare Provider Details

I. General information

NPI: 1518264712
Provider Name (Legal Business Name): SHELLEY ANN GANAWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLEY ANN UMFRESS CLPN

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2783 BENSON JONES RD
FULTON MS
38843-9714
US

IV. Provider business mailing address

2783 BENSON JONES RD
FULTON MS
38843-9714
US

V. Phone/Fax

Practice location:
  • Phone: 662-871-3272
  • Fax:
Mailing address:
  • Phone: 662-871-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number920845
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: