Healthcare Provider Details

I. General information

NPI: 1871506329
Provider Name (Legal Business Name): MICHELA R SHELTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELA MARGARET RUSSO RN,NP

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE VETERAN'S ADMINISTRATION HOSPITAL
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

115 S WALNUT BEND RD
CORDOVA TN
38018-7210
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax: 901-577-7415
Mailing address:
  • Phone: 901-755-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN0000045493
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: