Provider Demographics
NPI:1821082926
Name:SHELTON, BETH ANN (RN,FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:RN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2435
Mailing Address - Country:US
Mailing Address - Phone:325-677-5201
Mailing Address - Fax:325-677-3531
Practice Address - Street 1:1665 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1224
Practice Address - Country:US
Practice Address - Phone:325-793-5360
Practice Address - Fax:325-793-5357
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171485901Medicaid
TX171485901Medicaid
TX8D2556Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID