Healthcare Provider Details

I. General information

NPI: 1992635445
Provider Name (Legal Business Name): JASMINE SHELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2427 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3980
US

IV. Provider business mailing address

1418 HOLMES AVE
BOWLING GREEN KY
42104-3218
US

V. Phone/Fax

Practice location:
  • Phone: 270-936-7472
  • Fax:
Mailing address:
  • Phone: 615-359-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-537477
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: