Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 217303 | AR |
NPI | 1205599917 |
---|---|
Provider Name | Mrs. Valerie Ann Shelby |
First Address | Lavaca, AR 72941-3108 |
Second Address | Fort Smith, AR 72903-3755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2021 |
Last Update Date | 19/10/2021 |