Provider Demographics
NPI:1699592113
Name:FAST, SHELBY ANN
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:FAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8621 E BULL PINE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9258
Mailing Address - Country:US
Mailing Address - Phone:509-844-5805
Mailing Address - Fax:
Practice Address - Street 1:8621 E BULL PINE LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-9258
Practice Address - Country:US
Practice Address - Phone:509-844-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant