Healthcare Provider Details

I. General information

NPI: 1356805394
Provider Name (Legal Business Name): RYAN SHELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BRAINERD ST
PENSACOLA FL
32501-2680
US

IV. Provider business mailing address

101 E BRAINERD ST STE B
PENSACOLA FL
32501-2680
US

V. Phone/Fax

Practice location:
  • Phone: 850-332-3205
  • Fax: 850-828-2032
Mailing address:
  • Phone: 850-332-3205
  • Fax: 850-828-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11001048
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11001048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: