Provider Demographics
NPI:1770814576
Name:SHELTON, DALE KAY (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:DALE
Middle Name:KAY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 FM 2789
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:TX
Mailing Address - Zip Code:75559-6103
Mailing Address - Country:US
Mailing Address - Phone:903-667-3295
Mailing Address - Fax:
Practice Address - Street 1:1282 FM 2789
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:TX
Practice Address - Zip Code:75559-6103
Practice Address - Country:US
Practice Address - Phone:903-667-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231343363LF0000X
ARA01831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily