Basic Information
| Provider Information | |||||||||
| NPI: | 1477889400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHELTON | ||||||||
| FirstName: | ELISHA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HATFIELD | ||||||||
| OtherFirstName: | ELISHA | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9900 N CENTRAL EXPY | ||||||||
| Address2: | STE 215 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752310929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143964950 | ||||||||
| FaxNumber: | 8774235360 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 PRESTON PARK BLVD STE 1850 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750933633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728674658 | ||||||||
| FaxNumber: | 9728678696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2009 | ||||||||
| LastUpdateDate: | 05/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA05818 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.