Provider Demographics
NPI:1417561614
Name:BILBRO, SHELLY ANN (NP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:BILBRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 RUSHTON CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8170
Mailing Address - Country:US
Mailing Address - Phone:601-214-7172
Mailing Address - Fax:
Practice Address - Street 1:836 RUSHTON CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-8170
Practice Address - Country:US
Practice Address - Phone:601-214-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner