Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 18233 | TN |
NPI | 1003215997 |
---|---|
Provider Name | Princess Shelton |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-2771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 26/10/2020 |