Individual
SHELLI A. JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
6507 E STATE BLVD, FORT WAYNE, IN 46815-7026
(260) 486-3300
(260) 486-3600
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28099610
IN
363L00000X
Nurse Practitioner
Primary
71000494A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000376642
ANTHEM BCBS
IN
05
—
200375790
—
IN
Enumeration date
11/14/2005
Last updated
04/11/2025
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