Provider Demographics
NPI:1225650138
Name:TRIPOD, SHELBY (DO)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:TRIPOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3142
Mailing Address - Country:US
Mailing Address - Phone:870-972-8181
Mailing Address - Fax:870-935-8749
Practice Address - Street 1:415 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3142
Practice Address - Country:US
Practice Address - Phone:870-972-8181
Practice Address - Fax:870-974-7001
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-18526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program