Provider Demographics
NPI:1164735221
Name:SHELTON, KIMBERLY F (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:F
Last Name:SHELTON
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 1:1400 DOWELL SPRINGS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2457
Mailing Address - Country:US
Mailing Address - Phone:865-437-3977
Mailing Address - Fax:865-439-3912
Practice Address - Street 1:1400 DOWELL SPRINGS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2457
Practice Address - Country:US
Practice Address - Phone:865-437-3977
Practice Address - Fax:865-437-3912
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520351Medicaid
10350I348Medicare PIN