Provider Demographics
NPI:1053008847
Name:GERHARDT, SHELBY ALEASE (NP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALEASE
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 ALSTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7425
Mailing Address - Country:US
Mailing Address - Phone:205-482-3318
Mailing Address - Fax:
Practice Address - Street 1:1000 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4804
Practice Address - Country:US
Practice Address - Phone:205-930-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-181261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty