Shelly Ebert, F.N.P.
Individual provider Active NPI Nurse Practitioner · Highland, UT
NPI 1659307809 · NPPES record last updated Jun 28, 2022
Key facts
- NPI
- 1659307809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 219649-4405 (UT)
- Practice address
- 10968 N Alpine Hwy
Highland, UT 84003-8874 - Phone
- (801) 763-2900
- Fax
- (801) 763-2929
- NPI assigned
- Jun 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060830000441 | UT | Practitioner - Nurse Practitioner | 9638173834 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 219649-4405 | UT | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients |
Locations
1159 E 200 N
Ste 150
American Fork, UT 84003
Phone (801) 763-0652
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
10968 N Alpine Hwy
Highland, UT 84003
Phone (801) 763-2900
36 S State St
Ste 950
Salt Lake City, UT 84111
Phone (801) 442-1466
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 219649-4405 | UT | Yes |
Addresses
Primary practice location
10968 N Alpine Hwy
Highland, UT 84003-8874
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 855-2900
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | shelly.ebert@direct.imail.org |
Other providers in Highland, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.