MEDICARE: DR. THOMAS AUSTIN SHELTON DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	215180	TN
2	363LP0200X	Pediatric Nurse Practitioner	AP61251613	WA
3	363LP0200X	Pediatric Nurse Practitioner	30906	TN

General Provider Information

NPI Number	:	1245999572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS AUSTIN SHELTON DNP

Provider Business Mailing Address
First Line	:	4799 ROCKY RIVER RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37416-3139
Country	:	US
Telephone Number	:	706-847-1323
Fax Number	:

Provider Business Practice Location Address
First Line	:	5564 LITTLE DEBBIE PKWY # 114
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-4356
Country	:	US
Telephone Number	:	423-602-9545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	09/29/2022

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