Provider Demographics
NPI:1891151494
Name:SHELTON, MICHELLE MALZAHN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MALZAHN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CHRISTINE
Other - Last Name:MALZAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:RED RIVER CARDIOLOGY
Mailing Address - Street 2:201 4TH STREET, STE. 4A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8421
Mailing Address - Country:US
Mailing Address - Phone:318-442-8698
Mailing Address - Fax:308-209-4649
Practice Address - Street 1:RED RIVER CARDIOLOGY
Practice Address - Street 2:201 4TH STREET, STE. 4A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8421
Practice Address - Country:US
Practice Address - Phone:318-442-8698
Practice Address - Fax:308-209-4649
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA300926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant