Healthcare Provider Details

I. General information

NPI: 1639832645
Provider Name (Legal Business Name): AMY LEIGH SHELTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2021
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E VANN RD
GREENEVILLE TN
37743-7202
US

IV. Provider business mailing address

438 E VANN RD STE 9
GREENEVILLE TN
37743-7202
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-0491
  • Fax:
Mailing address:
  • Phone: 423-636-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000030300
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: