Provider Demographics
NPI:1174571343
Name:SHELTON, WALTER III (CRNA)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:SHELTON
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3676 BILLINGS ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6888
Mailing Address - Country:US
Mailing Address - Phone:904-557-8561
Mailing Address - Fax:
Practice Address - Street 1:1001 SAM PERRY BLVD
Practice Address - Street 2:MARY WASHINGTON HOSPITAL
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4453
Practice Address - Country:US
Practice Address - Phone:540-741-7614
Practice Address - Fax:540-741-7615
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172500367500000X
FLARNP1859212367500000X
MEAA083444367500000X
VA0024166332367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000531601OtherMEDICARE - MDIH
FLG2936OtherBC/BS FL
FL301633100Medicaid
GA550353313BMedicaid
430068749OtherRAILROAD RETIREMENT
FLG2936OtherBC/BS FL
430068749OtherRAILROAD RETIREMENT