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NPI Code Detail

MEDICARE: MRS. AMBER BEASLEY SHELL CRNP

MEDICARE: MRS. AMBER BEASLEY SHELL CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1-126061AL

General Provider Information

NPI Number : 1104348812
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMBER BEASLEY SHELL CRNP
Provider Business Mailing Address
First Line : 420 LOWELL DRIVE
Second Line : SUITE 204
City : HUNTSVILLE
State : AL
Zip : 35801
Country : US
Telephone Number : 256-536-9031
Fax Number :
Provider Business Practice Location Address
First Line : 1120 S JACKSON HWY STE 201
Second Line :
City : SHEFFIELD
State : AL
Zip : 35660-5770
Country : US
Telephone Number : 256-314-2550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2017
Last Update Date : 03/17/2018

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