Provider Demographics
NPI:1285028795
Name:BOOKER-SHELTON, KELLEY
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:BOOKER-SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10463 GRANT LINE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4049
Mailing Address - Country:US
Mailing Address - Phone:916-833-1864
Mailing Address - Fax:916-685-4540
Practice Address - Street 1:10463 GRANT LINE RD STE 118
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4049
Practice Address - Country:US
Practice Address - Phone:916-833-1864
Practice Address - Fax:916-685-4540
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver