Provider Demographics
NPI:1164837134
Name:SKELTON, AUSTIN PAUL (FNP)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:PAUL
Last Name:SKELTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87983 TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-8775
Mailing Address - Country:US
Mailing Address - Phone:541-935-2200
Mailing Address - Fax:541-935-6241
Practice Address - Street 1:87983 TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-8775
Practice Address - Country:US
Practice Address - Phone:541-935-2200
Practice Address - Fax:541-935-6241
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR041133163WA2000X
OR201608332NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator