Provider Demographics
NPI:1376808022
Name:SHELTON-TREECE, JESSICA LUCILLE (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LUCILLE
Last Name:SHELTON-TREECE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6420 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-1530
Mailing Address - Country:US
Mailing Address - Phone:916-945-9700
Mailing Address - Fax:913-945-9707
Practice Address - Street 1:6420 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-1530
Practice Address - Country:US
Practice Address - Phone:913-945-9700
Practice Address - Fax:913-945-9707
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS9408012207Q00000X
MO2015010575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine