Provider Demographics
NPI:1528019452
Name:SHELTON, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 S PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3860
Mailing Address - Country:US
Mailing Address - Phone:972-382-1000
Mailing Address - Fax:972-382-1167
Practice Address - Street 1:1771 S PRESTON RD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3860
Practice Address - Country:US
Practice Address - Phone:972-382-1000
Practice Address - Fax:972-382-1167
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK21765OtherOK LICENSE #
OKH47259Medicare UPIN