Provider Demographics
NPI:1447894167
Name:GERTEISEN, SHELLY CHRISTIAN (FNP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:CHRISTIAN
Last Name:GERTEISEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:541A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1429
Mailing Address - Country:US
Mailing Address - Phone:812-618-1128
Mailing Address - Fax:812-618-3081
Practice Address - Street 1:541A MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1429
Practice Address - Country:US
Practice Address - Phone:812-618-1128
Practice Address - Fax:812-618-3081
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013546363LF0000X
IN71009653A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14573272OtherCAQH
KY7100640130Medicaid