SHELLY Y GRESHAM RNC-FNP
NPI 1063491405
Nurse Practitioner in Poplar Bluff, MO

Active since January 13, 2006PECOS Enrolled
2480 THREE RIVERS BLVD, POPLAR BLUFF, MO 63901(573) 686-5564(573) 686-2838 Get Directions Write a Review

NPPES record last updated: September 22, 2009. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Shelly Y Gresham Rnc-fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELLY Y GRESHAM RNC-FNP (NPI 1063491405) is an individual nurse practitioner in Poplar Bluff, Missouri, licensed in Missouri (126637) and active in the NPI registry since January 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063491405
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameSHELLY Y GRESHAMCredential: RNC-FNP
Location Address2480 THREE RIVERS BLVDPoplar Bluff, MO 63901-2318
Mailing Address2480 Three Rivers BlvdPoplar Bluff, MO 63901-2318 · (573) 686-5564 · Fax (573) 686-2838
Fax(573) 686-2838
Sole ProprietorNo
Enumeration DateJanuary 13, 2006
Last NPPES UpdateSeptember 22, 2009
NPI 1063491405 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License Licensed in MO · 126637
Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

2480 THREE RIVERS BLVD, Poplar Bluff, MO 63901

Other Names 1

Former Name (1)Shelly Y Beardsley

Other Identifiers 3

Medicare UPINS30880MO
Medicare PIN817734039MO
Medicaid428569842MO

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Shelly Y Gresham Rnc-fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63901 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.64 typical visit price
range $52.28 – $161.24
Typical copayment $20.41 (range $13.07 – $40.31)
Most-billed visit code 99203
Established Patient
$93.24 typical visit price
range $16.30 – $131.05
Typical copayment $23.31 (range $4.07 – $32.76)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Clinic/Center (Rural Health)
2480 THREE RIVERS BLVD
POPLAR BLUFF, MO 63901
Nurse Practitioner
2480 THREE RIVERS BLVD
POPLAR BLUFF, MO 63901
Family Medicine
2480 THREE RIVERS BLVD
POPLAR BLUFF, MO 63901
Clinic/Center (Primary Care)
2480 THREE RIVERS BLVD
POPLAR BLUFF, MO 63901
Physician Assistant
2480 THREE RIVERS BLVD
POPLAR BLUFF, MO 63901
Family Medicine
2480 THREE RIVERS BLVD
POPLAR BLUFF, MO 63901

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1063491405, enumerated as an "individual" on January 13, 2006.

The provider is located at 2480 THREE RIVERS BLVD POPLAR BLUFF, MO 63901 and the phone number is (573) 686-5564.

Nurse Practitioner with taxonomy code 363L00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.