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General NPI Number Information
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NPI Number | 1154893881
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Entity Type | Individual
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Provider Name | SHELLEY RENEE THOMPSON AGNP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 1460 E CALVADA BLVD
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City | PAHRUMP
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State | NV
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Zip | 89048-5822
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Country | US
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Telephone | 775-210-8333
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Fax | 775-346-9158
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Provider Business Mailing Address
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Address Line | 2190 E MESQUITE AVE
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City | PAHRUMP
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State | NV
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Zip | 89060-3427
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Country | US
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Telephone | 775-751-4500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 816085
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 816085
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License Number State | NV
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