Healthcare Provider Details

I. General information

NPI: 1457288011
Provider Name (Legal Business Name): MICHAEL EUGENE SHELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8231
US

IV. Provider business mailing address

1501 SUNRISE DR
MARYVILLE TN
37803-5637
US

V. Phone/Fax

Practice location:
  • Phone: 865-679-0415
  • Fax:
Mailing address:
  • Phone: 865-679-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number115702
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: