Healthcare Provider Details

I. General information

NPI: 1730057712
Provider Name (Legal Business Name): SHELBY LYNN FRADY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W MILLS ST # A
COLUMBUS NC
28722-9450
US

IV. Provider business mailing address

7966 BOYLSTON HWY
MILLS RIVER NC
28759-8665
US

V. Phone/Fax

Practice location:
  • Phone: 828-702-6748
  • Fax:
Mailing address:
  • Phone: 828-702-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023803
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: