Healthcare Provider Details

I. General information

NPI: 1245999572
Provider Name (Legal Business Name): THOMAS AUSTIN SHELTON DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5564 LITTLE DEBBIE PKWY # 114
COLLEGE DALE TN
37363-4356
US

IV. Provider business mailing address

4799 ROCKY RIVER RD
CHATTANOOGA TN
37416-3139
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-9545
  • Fax:
Mailing address:
  • Phone: 706-847-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number215180
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61251613
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number30906
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: