Provider Demographics
NPI:1962158121
Name:SHELTON, SARA ASHLEY (FNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ASHLEY
Other - Last Name:SENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 KRUPP AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 KRUPP AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4476
Practice Address - Country:US
Practice Address - Phone:512-663-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily