Individual
SHELLY Y GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC-FNP
Contact information
Practice address
2480 THREE RIVERS BLVD, POPLAR BLUFF, MO 63901-2318
(573) 686-5564
(573) 686-2838
Mailing address
2480 THREE RIVERS BLVD, POPLAR BLUFF, MO 63901-2318
(573) 686-5564
(573) 686-2838
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
126637
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428569842
—
MO
Enumeration date
01/13/2006
Last updated
09/22/2009
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