Healthcare Provider Details

I. General information

NPI: 1477623015
Provider Name (Legal Business Name): SHELBA JEAN WORKMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SHELBA JEAN LONG

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 KENMORE DRIVE
DANVILLE WV
25053
US

IV. Provider business mailing address

3375 US RT 60
HUNTINGTON WV
25705-2837
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7851
  • Fax: 304-369-1978
Mailing address:
  • Phone: 304-525-7851
  • Fax: 304-586-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0274623
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number38119
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: