Healthcare Provider Details

I. General information

NPI: 1053792002
Provider Name (Legal Business Name): KAYLA SHELTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA MIKEL FNP-BC

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PAGEANT LN STE 307
CLARKSVILLE TN
37040-3813
US

IV. Provider business mailing address

350 PAGEANT LN STE 307
CLARKSVILLE TN
37040-3813
US

V. Phone/Fax

Practice location:
  • Phone: 931-906-2001
  • Fax:
Mailing address:
  • Phone: 931-906-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19951
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: