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General NPI Number Information
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NPI Number | 1962283804
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Entity Type | Individual
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Provider Name | SHELBY MOOD FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 500 DAMONTE RANCH PKWY STE 929
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City | RENO
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State | NV
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Zip | 89521-5911
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Country | US
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Telephone | 775-841-6123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | VIRGINIA CITY
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State | NV
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Zip | 89440-0145
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 863564
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License Number State | NV
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