# MACKENZIE GRACE SHELTON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1982134003
- **Gender:** F
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 8384 | GA | Yes |

## Other

- **Enumeration date:** 06/13/2017
- **Last updated:** 04/23/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003191402A | — | GA |