Provider Demographics
NPI:1912933185
Name:SHELTON, JEANNETTE ELIZABETH (FNP)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:ELIZABETH
Last Name:SHELTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:ELIZABETH
Other - Last Name:FENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:POB SUITE 303
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-289-4941
Mailing Address - Fax:804-289-4707
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:POB SUITE 303
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-289-4941
Practice Address - Fax:804-289-4707
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily