Provider Demographics
NPI:1194335836
Name:VOGEL, SHELBY M (PA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:M
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210127
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-0127
Mailing Address - Country:US
Mailing Address - Phone:615-320-0007
Mailing Address - Fax:615-383-6329
Practice Address - Street 1:5653 FRIST BLVD STE 332
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2064
Practice Address - Country:US
Practice Address - Phone:615-320-0007
Practice Address - Fax:615-383-6329
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4274363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical