Healthcare Provider Details

I. General information

NPI: 1245306026
Provider Name (Legal Business Name): DEBRA MICHELLE SHELBY PHD, DNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 LA ORILLA RD NW STE D3
ALBUQUERQUE NM
87120-2742
US

IV. Provider business mailing address

3200 LA ORILLA RD NW STE D3
ALBUQUERQUE NM
87120-2742
US

V. Phone/Fax

Practice location:
  • Phone: 772-708-6776
  • Fax: 877-335-6410
Mailing address:
  • Phone: 772-708-6776
  • Fax: 877-335-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2218012
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP03118
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: