Provider Demographics
NPI:1447314802
Name:SHELKEY, MARY (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SHELKEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 NORTHUP WAY
Mailing Address - Street 2:SUITE E226
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1946
Mailing Address - Country:US
Mailing Address - Phone:206-552-6992
Mailing Address - Fax:206-829-9660
Practice Address - Street 1:11820 NORTHUP WAY
Practice Address - Street 2:SUITE E226
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1946
Practice Address - Country:US
Practice Address - Phone:206-552-6992
Practice Address - Fax:206-829-9660
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner