Provider Demographics
NPI:1962018630
Name:WILKINS -SHELTON, RAVEN (APRN)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:WILKINS -SHELTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1050 W ARKANSAS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6308
Mailing Address - Country:US
Mailing Address - Phone:816-702-1100
Mailing Address - Fax:
Practice Address - Street 1:1050 W ARKANSAS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6308
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily