Provider Demographics
NPI:1699350694
Name:BEARHEELS, SHELBY KYAN (PA-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:KYAN
Last Name:BEARHEELS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:KYAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 N DIERS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4985
Mailing Address - Country:US
Mailing Address - Phone:308-384-5400
Mailing Address - Fax:308-384-5201
Practice Address - Street 1:620 N DIERS AVE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4985
Practice Address - Country:US
Practice Address - Phone:308-384-5400
Practice Address - Fax:308-384-5201
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE2808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program