Provider Demographics
NPI:1770391278
Name:SHELTON, JODY WARREN (APRN)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:WARREN
Last Name:SHELTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 BALLPARK RD
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-4859
Mailing Address - Country:US
Mailing Address - Phone:270-580-4778
Mailing Address - Fax:270-580-4779
Practice Address - Street 1:83 BALLPARK RD
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-4859
Practice Address - Country:US
Practice Address - Phone:270-580-4778
Practice Address - Fax:270-580-4779
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4033386363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care