Provider Demographics
NPI:1770575557
Name:SHELTON, THOMAS (LAT, ATC, RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:LAT, ATC, RN
Other - Prefix:
Other - First Name:TC
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT, ATC, APRN, FNP-
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-487-1588
Mailing Address - Fax:843-487-1590
Practice Address - Street 1:705 N 8TH AVE STE 1B
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2549
Practice Address - Country:US
Practice Address - Phone:843-487-1588
Practice Address - Fax:843-487-1590
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR103177163W00000X
ARAT 2772255A2300X
AR125715363LF0000X
SC26521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer