Provider Demographics
NPI:1134625999
Name:SHELTON, JULIE ANN (NP-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MCNEILL LN
Mailing Address - Street 2:
Mailing Address - City:CASEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62232-2091
Mailing Address - Country:US
Mailing Address - Phone:618-792-6060
Mailing Address - Fax:
Practice Address - Street 1:5690 CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2335
Practice Address - Country:US
Practice Address - Phone:314-731-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017041085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner