Provider Demographics
NPI:1659578458
Name:SHELTON, DEBBIE (NP)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PETRO RD
Mailing Address - Street 2:STE 11
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AS
Mailing Address - Zip Code:72301
Mailing Address - Country:US
Mailing Address - Phone:870-732-0332
Mailing Address - Fax:870-732-3078
Practice Address - Street 1:3900 PETRO RD
Practice Address - Street 2:STE 11
Practice Address - City:WEST MEMPHIS
Practice Address - State:AS
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-732-0332
Practice Address - Fax:870-732-3078
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001128363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAO1128ANP-R36313OtherSTATE LICENSE