Provider Demographics
NPI:1194544726
Name:HULSEY, SHELLY LYNN (CNM)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:HULSEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 HULSEY PATH
Mailing Address - Street 2:
Mailing Address - City:ROBERTSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63072-2216
Mailing Address - Country:US
Mailing Address - Phone:314-604-8449
Mailing Address - Fax:
Practice Address - Street 1:965 MATTOX DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2365
Practice Address - Country:US
Practice Address - Phone:314-747-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014022750363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology