Provider Demographics
NPI:1174097000
Name:CALK GREENVILLE, SHELBIE C (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:SHELBIE
Middle Name:C
Last Name:CALK GREENVILLE
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:SHELBIE
Other - Middle Name:
Other - Last Name:CALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:316 EDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-7518
Mailing Address - Country:US
Mailing Address - Phone:936-465-6997
Mailing Address - Fax:
Practice Address - Street 1:2400 N STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-1222
Practice Address - Country:US
Practice Address - Phone:936-205-1721
Practice Address - Fax:866-259-8676
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered