Individual
SHELLEY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8921 SOUTHPOINTE DR, INDIANAPOLIS, IN 46227-1084
(317) 355-3155
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71009998A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300088373
—
IN
Enumeration date
04/22/2020
Last updated
04/05/2024
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