Individual provider Active NPI

Catherine Shelton, PA

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1144295742
Registry record updated Oct 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
645411 Issued in TX
Practice address
520 E Douglas Blvd
Tyler, TX 75702-8307
Phone
(903) 592-5618
NPI assigned
Feb 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 645411 TX Primary

Addresses

Primary practice location

520 E Douglas Blvd
Tyler, TX 75702-8307

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6450

Other identifiers 3

IdentifierTypeStateIssuer
75-2616977-121OtherTXTRICARE
TIN PLUS SUFFIX 007OtherTXTRICARE
167486301MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040917000339 TX Practitioner - Nurse Practitioner 6103894266 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Physician Assistant

State licenses

LicenseStateTypeSpecialty
645411TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Trincare Inc Current Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 12, 2004 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Mar 1, 2020 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 12, 2004 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Mar 1, 2020 Accepting new patients

Locations

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

8288 S Broadway Ave
Tyler, TX 75703
Phone (903) 531-5433

520 Douglas Blvd
Tyler, TX 75702
Phone (903) 510-1175

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413244800000",
    "number": "1144295742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E DOUGLAS BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028307",
            "telephone_number": "903-592-5618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "CATHERINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2014-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "645411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-121",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "TIN PLUS SUFFIX 007",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167486301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.