Provider Demographics
NPI:1891681466
Name:COUP, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:COUP
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 1:17374 E WOOLSEY WAY
Mailing Address - Street 2:
Mailing Address - City:RIO VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85263-5357
Mailing Address - Country:US
Mailing Address - Phone:480-748-0151
Mailing Address - Fax:
Practice Address - Street 1:2000 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8759
Practice Address - Country:US
Practice Address - Phone:928-226-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant