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NPI Code Detail

MEDICARE: KELSEY SHASTEEN

MEDICARE: KELSEY SHASTEEN
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
1363LA2200XAdult Health Nurse Practitioner29455TN
2163W00000XRegistered Nurse0000214051TN

General Provider Information

NPI Number : 1730742479
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY SHASTEEN
Provider Business Mailing Address
First Line : 2548 RIDEOUT LN
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128-7686
Country : US
Telephone Number : 615-410-4990
Fax Number : 615-410-4250
Provider Business Practice Location Address
First Line : 2548 RIDEOUT LN
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128-7686
Country : US
Telephone Number : 615-410-4990
Fax Number : 615-410-4250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2019
Last Update Date : 06/02/2022

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Directions to “ KELSEY SHASTEEN ” Practice Location

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