Healthcare Provider Details

I. General information

NPI: 1316009509
Provider Name (Legal Business Name): JOSEPH T SHELTON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14662 N US HIGHWAY 25 E
CORBIN KY
40701-6425
US

IV. Provider business mailing address

121 BISHOP ST
CORBIN KY
40701-1702
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-9005
  • Fax: 606-528-8272
Mailing address:
  • Phone: 606-528-2124
  • Fax: 606-528-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA324
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: