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General NPI Number Information
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NPI Number | 1780961987
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Entity Type | Individual
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Provider Name | SHELLY MARIE HARGROVE NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 6688 NOLENSVILLE RD STE 108
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City | BRENTWOOD
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State | TN
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Zip | 37027-8873
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Country | US
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Telephone | 706-799-2749
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Fax |
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Provider Business Mailing Address
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Address Line | 376 MALONE RD
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City | PULASKI
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State | TN
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Zip | 38478-8729
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Country | US
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Telephone | 931-638-1463
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16278
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License Number State | TN
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