Healthcare Provider Details

I. General information

NPI: 1053102772
Provider Name (Legal Business Name): SHELBY TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HERITAGE WAY STE 2100
KALISPELL MT
59901-3167
US

IV. Provider business mailing address

6419 GIRARD AVE
CINCINNATI OH
45213-1223
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-8992
  • Fax: 406-257-8996
Mailing address:
  • Phone: 270-766-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0038481
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number266773
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: