Provider Demographics
NPI:1548692700
Name:SHELDON, JENNIFER JEAN (NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:SHELDON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 POPLAR ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3336
Mailing Address - Country:US
Mailing Address - Phone:478-746-0097
Mailing Address - Fax:478-750-9594
Practice Address - Street 1:446 POPLAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3336
Practice Address - Country:US
Practice Address - Phone:478-746-0097
Practice Address - Fax:478-750-9594
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180629363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE50341Medicare UPIN