Provider Demographics
NPI:1497984181
Name:SHELLEY, HEATHER LYNN (FNP, CPM)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:FNP, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 W. MAIN ST.
Mailing Address - Street 2:#206
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2078
Mailing Address - Country:US
Mailing Address - Phone:801-615-1733
Mailing Address - Fax:385-374-9774
Practice Address - Street 1:394 W. MAIN ST.
Practice Address - Street 2:#206
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2078
Practice Address - Country:US
Practice Address - Phone:801-796-2229
Practice Address - Fax:385-374-9774
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7362478-3400176B00000X
UT7362478-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No176B00000XOther Service ProvidersMidwife