Provider Demographics
NPI:1619534864
Name:SHELTON, CHRISTY M (AGNP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:M
Last Name:SHELTON
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-3344
Mailing Address - Country:US
Mailing Address - Phone:318-435-3771
Mailing Address - Fax:318-435-3842
Practice Address - Street 1:2106 LOOP RD STE B
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3343
Practice Address - Country:US
Practice Address - Phone:318-435-3771
Practice Address - Fax:318-435-3842
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP.206527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner