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General NPI Number Information
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NPI Number | 1659918936
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Entity Type | Individual
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Provider Name | SHELBY ELAINE GIBSON APRN
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Gender | Female
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 507 N CHURCH ST STE A
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City | MONTICELLO
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State | AR
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Zip | 71655-4316
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Country | US
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Telephone | 870-888-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 540 GIBSON RD
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City | RISON
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State | AR
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Zip | 71665-8284
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Country | US
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Telephone | 870-723-5697
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Fax | 870-252-2793
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 122181
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License Number State | AR
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