Provider Demographics
NPI:1871506329
Name:SHELTON, MICHELA R (NP)
Entity Type:Individual
Prefix:
First Name:MICHELA
Middle Name:R
Last Name:SHELTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELA
Other - Middle Name:MARGARET
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,NP
Mailing Address - Street 1:115 S WALNUT BEND RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7210
Mailing Address - Country:US
Mailing Address - Phone:901-755-7389
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:VETERAN'S ADMINISTRATION HOSPITAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7415
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000045493363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health