Provider Demographics
NPI:1457012825
Name:SHELTON, KYLIE (LVN)
Entity Type:Individual
Prefix:MS
First Name:KYLIE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 VERDE ST
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-5127
Mailing Address - Country:US
Mailing Address - Phone:409-433-1265
Mailing Address - Fax:
Practice Address - Street 1:2615 CALDER ST STE 610
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1947
Practice Address - Country:US
Practice Address - Phone:281-968-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347297164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse