Healthcare Provider Details

I. General information

NPI: 1467439422
Provider Name (Legal Business Name): SHELLY MCCLUNG SOMERS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BUTLER ST
MERCER PA
16137-1090
US

IV. Provider business mailing address

400 W BUTLER ST
MERCER PA
16137-1090
US

V. Phone/Fax

Practice location:
  • Phone: 724-662-4990
  • Fax: 724-662-2782
Mailing address:
  • Phone: 724-662-4990
  • Fax: 724-662-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP005608B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: