Provider Demographics
NPI:1295167484
Name:CROSSMAN, SHELLY LYNN (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:CROSSMAN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LYNN
Other - Last Name:FRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:1042 WILLOW CREEK RD SUITE A101
Mailing Address - Street 2:PO BOX 416
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1673
Mailing Address - Country:US
Mailing Address - Phone:928-499-2915
Mailing Address - Fax:877-406-3180
Practice Address - Street 1:448 N STATE ROUTE 89 STE H
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5957
Practice Address - Country:US
Practice Address - Phone:928-499-2915
Practice Address - Fax:877-406-3180
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337984-1363LF0000X
AZAP11069363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ395116Medicaid