Provider Demographics
NPI:1811108517
Name:SHELTON, WILLIE TREGG (MPAS, PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:TREGG
Last Name:SHELTON
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Gender:M
Credentials:MPAS, PA-C
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Mailing Address - Street 1:390 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446
Mailing Address - Country:US
Mailing Address - Phone:337-238-9507
Mailing Address - Fax:
Practice Address - Street 1:BAYNE-JONES ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:1585 3RD ST.
Practice Address - City:FT POLK
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:337-531-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2021-10-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant