Provider Demographics
NPI:1639284581
Name:HOUSE, SHELBY CHRISTINA MARGARET (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHELBY CHRISTINA
Middle Name:MARGARET
Last Name:HOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:CHRISTINA
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1473 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7751
Practice Address - Country:US
Practice Address - Phone:502-584-2029
Practice Address - Fax:812-752-4654
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08278363A00000X
KYPA950363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000693053OtherANTHEM - NCVA
KY7100172580Medicaid
KY000000557897OtherANTHEM BLUE CROSS BLUE SHIELD
KY000057080TOtherHUMANA - NCVA
KY50033948OtherPASSPORT & PASSPORT ADVTG
KYP400032392Medicare PIN
KY000057080TOtherHUMANA - NCVA
KYQ72090Medicare UPIN