Healthcare Provider Details

I. General information

NPI: 1407581333
Provider Name (Legal Business Name): SHELBY BILLEAUD HARLOCK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 STELZER RD
COLUMBUS OH
43219-3133
US

IV. Provider business mailing address

858 CENTERWOOD DR
CHARLESTON SC
29412-3513
US

V. Phone/Fax

Practice location:
  • Phone: 614-472-2880
  • Fax:
Mailing address:
  • Phone: 614-564-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031701
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27456
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: