Provider Demographics
NPI:1215707195
Name:DYE, SHELBY SUMNER (DNP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:SUMNER
Last Name:DYE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LAKELAND DR STE 505
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8854
Mailing Address - Country:US
Mailing Address - Phone:601-936-0681
Mailing Address - Fax:
Practice Address - Street 1:1026 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9532
Practice Address - Country:US
Practice Address - Phone:601-932-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS909910163W00000X
MS901883367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse