Provider Demographics
NPI:1568522118
Name:NESMITH, DOROTHY SHELTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:SHELTON
Last Name:NESMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:SHELTON
Other - Last Name:NESMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6031 EAST MAIN STREET
Mailing Address - Street 2:#318
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3590
Mailing Address - Country:US
Mailing Address - Phone:469-859-2577
Mailing Address - Fax:
Practice Address - Street 1:7200 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1703
Practice Address - Country:US
Practice Address - Phone:469-859-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-42072208100000X
WV29551208100000X
IN01084275A208100000X
NJ25MA11025800208100000X
NY315993208100000X
OH35.145450208100000X
TXL4597208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
8GF521OtherBCBS
TX1542565-01Medicaid
TXH65192Medicare UPIN
TX00837FMedicare ID - Type UnspecifiedMEDICARE