Healthcare Provider Details

I. General information

NPI: 1962784603
Provider Name (Legal Business Name): SHELLY HOWARD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3183 W STATE ST STE 1201
BRISTOL TN
37620-1713
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 423-764-0987
  • Fax:
Mailing address:
  • Phone: 423-952-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number16116
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: