Provider Demographics
NPI:1245999572
Name:SHELTON, THOMAS AUSTIN (DNP)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:AUSTIN
Last Name:SHELTON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4799 ROCKY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-3139
Mailing Address - Country:US
Mailing Address - Phone:706-847-1323
Mailing Address - Fax:
Practice Address - Street 1:5564 LITTLE DEBBIE PKWY # 114
Practice Address - Street 2:
Practice Address - City:COLLEGE DALE
Practice Address - State:TN
Practice Address - Zip Code:37363-4356
Practice Address - Country:US
Practice Address - Phone:423-602-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN215180163WP0200X
WAAP61251613363LP0200X
TN30906363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics