Provider Demographics
NPI:1366203762
Name:HENSLEY, SHELLIE ANN
Entity type:Individual
Prefix:
First Name:SHELLIE
Middle Name:ANN
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLIE
Other - Middle Name:ANN
Other - Last Name:SIMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2125
Mailing Address - Country:US
Mailing Address - Phone:307-746-2182
Mailing Address - Fax:833-941-2527
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2125
Practice Address - Country:US
Practice Address - Phone:307-746-2182
Practice Address - Fax:833-941-2527
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY53668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily