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

Q: What is Shelly Gresham's NPI number?

The NPI number for Shelly Gresham is 1063491405. It was assigned to this individual provider in the NPPES registry on January 13, 2006. The provider is also known as Shelly Y Beardsley.

Q: What is Shelly Gresham's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Shelly Gresham was last updated on September 22, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 13, 2006

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: August 23, 2026.

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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.

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

Phone(573) 686-5564

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

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Other Names 1

Former Name (1)Shelly Y Beardsley

Other Identifiers 3

Medicare UPINS30880MO

Medicare PIN817734039MO

Medicaid428569842MO

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.

JAMES W ROBINETT JR.

Physician Assistant