Provider Demographics
NPI:1962998096
Name:ERNEST, SHELBY LYNN (NP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:ERNEST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5049 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7080
Mailing Address - Country:US
Mailing Address - Phone:701-356-1001
Mailing Address - Fax:701-639-4550
Practice Address - Street 1:5049 33RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7080
Practice Address - Country:US
Practice Address - Phone:701-356-1001
Practice Address - Fax:701-639-4550
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily