Individual
CATHERINE SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
520 E DOUGLAS BLVD, TYLER, TX 75702-8307
(903) 592-5618
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
645411
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167486301
—
TX
01
—
75-2616977-121
TRICARE
TX
01
—
TIN PLUS SUFFIX 007
TRICARE
TX
Enumeration date
02/17/2006
Last updated
10/14/2014
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