Provider Demographics
NPI:1346085909
Name:BRUTON, SHAY ELLARD (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHAY
Middle Name:ELLARD
Last Name:BRUTON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:SHAY
Other - Last Name:ELLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1557 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-3218
Mailing Address - Country:US
Mailing Address - Phone:251-478-4900
Mailing Address - Fax:
Practice Address - Street 1:1557 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3218
Practice Address - Country:US
Practice Address - Phone:251-478-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAG01240061363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology