Provider Demographics
NPI:1134329469
Name:SHELTON, MONICA MOSS (KY CERT 1ST ASSIST)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MOSS
Last Name:SHELTON
Suffix:
Gender:F
Credentials:KY CERT 1ST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 IRISH CIR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1779
Mailing Address - Country:US
Mailing Address - Phone:270-886-9284
Mailing Address - Fax:
Practice Address - Street 1:382 IRISH CIR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1779
Practice Address - Country:US
Practice Address - Phone:270-886-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
KYSA031246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other