Provider Demographics
NPI:1154893881
Name:THOMPSON, SHELLEY RENEE (AGNP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:RENEE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP
Mailing Address - Street 1:2190 E MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-3427
Mailing Address - Country:US
Mailing Address - Phone:775-751-4500
Mailing Address - Fax:
Practice Address - Street 1:1460 E CALVADA BLVD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5822
Practice Address - Country:US
Practice Address - Phone:775-210-8333
Practice Address - Fax:775-346-9158
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV816085363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV816085OtherSTATE LICENSE