Provider Demographics
NPI:1447077433
Name:PRATER, SHELBY ALEXANDRA
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALEXANDRA
Last Name:PRATER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:JORDISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 WOODCROFT TRL
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45430-1980
Practice Address - Country:US
Practice Address - Phone:937-427-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily