Individual
MRS. JILL E SHELBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 446-7029
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71002060
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71002060A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000897835
ANTHEM PROVIDER NUMBER
IN
05
—
200860380
—
IN
Enumeration date
07/04/2006
Last updated
11/15/2021
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