Provider Demographics
NPI:1134234958
Name:SHELTON, DOYLE LYN (PA)
Entity type:Individual
Prefix:
First Name:DOYLE
Middle Name:LYN
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VANDERBILT PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1700
Mailing Address - Country:US
Mailing Address - Phone:828-274-6000
Mailing Address - Fax:
Practice Address - Street 1:189 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-3035
Practice Address - Country:US
Practice Address - Phone:828-652-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103597363A00000X, 363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101846Medicaid
NC1134234958Medicaid
P00397570OtherRAILROAD MEDICARE
SC0202PAMedicaid
NCNC5819AMedicare PIN
P69308Medicare UPIN
P00397570OtherRAILROAD MEDICARE
NC1134234958Medicaid
NCNC5819CMedicare PIN
NCNC5819BMedicare PIN