Provider Demographics
NPI:1669442562
Name:SHELTON, DAVID E (APRN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:SHELTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-566-6338
Practice Address - Street 1:118 PATRIOT DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9094
Practice Address - Country:US
Practice Address - Phone:502-331-9503
Practice Address - Fax:502-331-0334
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015898Medicaid
KYP00283050OtherRAILROAD MEDICARE
KY0289322Medicare PIN
KY0690822Medicare PIN
KY0640912Medicare PIN
KY00310013Medicare PIN
KY00308013Medicare PIN
KY1273227Medicare PIN
KY00311013Medicare PIN
Q54301Medicare UPIN
KY00546084Medicare Oscar/Certification
KY00313013Medicare PIN
KY78015898Medicaid
KY00314013Medicare PIN
KYP00632802Medicare PIN
KY00312013Medicare PIN
KY0715632Medicare PIN
KY00309013Medicare PIN