MEDICARE: HEATHER POWELL SHELTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L5904	TX

General Provider Information

NPI Number	:	1083717052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER POWELL SHELTON M.D.

Provider Business Mailing Address
First Line	:	2800 S HULEN ST
Second Line	:	SUITE 203
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1504
Country	:	US
Telephone Number	:	817-585-4544
Fax Number	:	817-744-8535

Provider Business Practice Location Address
First Line	:	2800 S HULEN ST
Second Line	:	SUITE 203
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1504
Country	:	US
Telephone Number	:	817-585-4544
Fax Number	:	817-744-8535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	01/04/2022

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