Provider Demographics
NPI:1063512077
Name:SHELTON, DEREK S (ARNP)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:S
Last Name:SHELTON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 READ ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1739
Mailing Address - Country:US
Mailing Address - Phone:812-424-9291
Mailing Address - Fax:812-421-2722
Practice Address - Street 1:515 READ ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1739
Practice Address - Country:US
Practice Address - Phone:812-424-9291
Practice Address - Fax:812-421-2722
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003826A363L00000X, 363LA2100X
KY42960363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care