Provider Demographics
NPI:1578291795
Name:SHELTON, BRIANNA LORAINE (BA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LORAINE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1235
Mailing Address - Country:US
Mailing Address - Phone:681-203-7566
Mailing Address - Fax:
Practice Address - Street 1:1401 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1235
Practice Address - Country:US
Practice Address - Phone:681-203-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant