Provider Demographics
NPI:1821417825
Name:SHELTON, JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 21ST AVE S
Mailing Address - Street 2:CC-3322 MEDICAL CENTER NORTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2561
Mailing Address - Country:US
Mailing Address - Phone:615-343-4882
Mailing Address - Fax:
Practice Address - Street 1:1115 W 17TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-1800
Practice Address - Country:US
Practice Address - Phone:918-295-3400
Practice Address - Fax:918-585-1549
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32607390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program