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General NPI Number Information
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NPI Number | 1215862651
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Entity Type | Individual
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Provider Name | PORSCHIA SHANEY UPSHAW RN
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Gender | Female
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Dates
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Enumeration Date | 06/16/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 2701 HOLLY TRL
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-8914
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Country | US
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Telephone | 844-424-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 210 BROOKS ST
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City | DONIPHAN
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State | MO
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Zip | 63935-1220
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Country | US
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Telephone | 832-428-2663
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 2023038656
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License Number State | MO
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