MEDICARE: MRS. SHELLY MARIE HARGROVE NP-C

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
1	363LF0000X	Family Nurse Practitioner	16278	TN

General Provider Information

NPI Number	:	1780961987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLY MARIE HARGROVE NP-C

Provider Business Mailing Address
First Line	:	376 MALONE RD
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-8729
Country	:	US
Telephone Number	:	931-638-1463
Fax Number	:

Provider Business Practice Location Address
First Line	:	6688 NOLENSVILLE RD STE 108
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-8873
Country	:	US
Telephone Number	:	706-799-2749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	08/28/2024

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