Basic Information
| Provider Information | |||||||||
| NPI: | 1396961363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHELTON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | BARTON | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1059 LATROBE RD | ||||||||
| Address2: | |||||||||
| City: | WEST FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628965046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188897274 | ||||||||
| FaxNumber: | 6189975285 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 VETERANS MEMORIAL DR | ||||||||
| Address2: | SUITE 45 | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628645951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975266 | ||||||||
| FaxNumber: | 6189975285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 02/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.