Provider Demographics
NPI:1982374666
Name:SHELTON, JESSICA JEAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-0773
Mailing Address - Country:US
Mailing Address - Phone:701-202-4298
Mailing Address - Fax:
Practice Address - Street 1:303 6TH AVE NE
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746
Practice Address - Country:US
Practice Address - Phone:701-202-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant