Healthcare Provider Details

I. General information

NPI: 1386554558
Provider Name (Legal Business Name): SHELLEY ACORD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 WESTERN AVE
CHILLICOTHEE OH
45601-7506
US

IV. Provider business mailing address

2077 WESTERN AVE
CHILLICOTHEE OH
45601-7506
US

V. Phone/Fax

Practice location:
  • Phone: 740-708-5007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0043306
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: