| Doctor Name: | DR. SHELBY B POLK |
| NPI Number: | 1912014648 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, FNP-BC, CDE |
| License Number: | R852951 |
| Business Practice Address: | 840 N Oak Ave Ruleville, MS - 387713227 |
| Business Phone Number: | 6627564024 |
| Business Fax Number: | 6627564023 |
| Mailing Address: | 406 Bishop Rd, Apt J-104 CLEVELAND |
| State: | MS |
| Postal Code: | 387322959 |
| Phone Number: | 6662207491 |
| Fax Number: | |
| NPI Enumeration Date: | 08/25/2006 |
| NPI Last Update Date: | 06/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R852951 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |