Provider Demographics
NPI:1134661564
Name:SHELTON, MOLLY (CPNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SPRINGVILLE STA
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-6163
Mailing Address - Country:US
Mailing Address - Phone:205-773-2075
Mailing Address - Fax:
Practice Address - Street 1:350 SPRINGVILLE STA
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-6163
Practice Address - Country:US
Practice Address - Phone:205-773-2075
Practice Address - Fax:866-304-9633
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134322363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics