Provider Demographics
NPI:1427238898
Name:GOVER, SHELLEY RENEE (ARNP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:GOVER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2091
Mailing Address - Country:US
Mailing Address - Phone:859-236-1080
Mailing Address - Fax:859-236-1862
Practice Address - Street 1:303 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2091
Practice Address - Country:US
Practice Address - Phone:859-236-1080
Practice Address - Fax:859-236-1862
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004982363LN0000X
KY4982P364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3004982OtherAPRN LICENSE