Provider Demographics
NPI:1750001426
Name:SHELTON, KAITLYN SUZANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:SUZANNE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-1456
Mailing Address - Country:US
Mailing Address - Phone:423-817-8379
Mailing Address - Fax:
Practice Address - Street 1:1420 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-2522
Practice Address - Country:US
Practice Address - Phone:423-246-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist