Provider Demographics
NPI:1720429517
Name:SHELTON, TIMOTHY WADE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WADE
Last Name:SHELTON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4455
Mailing Address - Country:US
Mailing Address - Phone:615-988-1571
Mailing Address - Fax:615-988-1635
Practice Address - Street 1:2131 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4455
Practice Address - Country:US
Practice Address - Phone:615-988-1571
Practice Address - Fax:615-988-1635
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily