Provider Demographics
NPI:1588968226
Name:ESTES, SHELLEY L (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:L
Last Name:ESTES
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:3101 RICHMOND RD STE 190
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1525
Practice Address - Country:US
Practice Address - Phone:859-309-7613
Practice Address - Fax:877-722-0592
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2025-02-19
Deactivation Date:2022-08-31
Deactivation Code:
Reactivation Date:2022-10-04
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY3018312363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100861710Medicaid
KY7100890470Medicaid