Healthcare Provider Details

I. General information

NPI: 1154893881
Provider Name (Legal Business Name): SHELLEY RENEE THOMPSON AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY RENEE THOMPSON AGNP

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 E CALVADA BLVD
PAHRUMP NV
89048-5822
US

IV. Provider business mailing address

2190 E MESQUITE AVE
PAHRUMP NV
89060-3427
US

V. Phone/Fax

Practice location:
  • Phone: 775-210-8333
  • Fax: 775-346-9158
Mailing address:
  • Phone: 775-751-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number816085
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number816085
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: