Provider Demographics
NPI:1396961363
Name:SHELTON, AMANDA BARTON (CNM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BARTON
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 LATROBE RD
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-5046
Mailing Address - Country:US
Mailing Address - Phone:618-889-7274
Mailing Address - Fax:618-997-5285
Practice Address - Street 1:3130 VETERANS MEMORIAL DR
Practice Address - Street 2:SUITE 45
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5951
Practice Address - Country:US
Practice Address - Phone:618-997-5266
Practice Address - Fax:618-997-5285
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife