Healthcare Provider Details

I. General information

NPI: 1053953927
Provider Name (Legal Business Name): SHANETHA KEELAH STAPLETON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2019
Last Update Date: 10/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

IV. Provider business mailing address

PO BOX 9225
ST THOMAS VI
00801-2225
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4500
  • Fax: 559-261-1526
Mailing address:
  • Phone: 340-998-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: