Shanna Lynn White

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71006501A Issued in IN

Practice address

210 W Broadway St
Shelburn, IN 47879-1202

Phone

(812) 562-0323

NPI assigned

Jul 26, 2016

Last updated

Mar 23, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Shanna Lynn Southwood Former name

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valle Vista LLCGroup PAC ID 8224948930, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Valle Vista, LLC

  dba Valle Vista Health System

  • Psychiatric Hospital
  • Greenwood, IN
  • NPI 1699722405
  Medicare reassignment Care Compare group NPD
• Valle Vista LLC

  dba New Vista North

  • Methadone Clinic
  • Indianapolis, IN
  • NPI 1548036262
  NPD

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1003369091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W BROADWAY ST",
            "city": "SHELBURN",
            "state": "IN",
            "postal_code": "478791202",
            "telephone_number": "812-562-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W BROADWAY ST",
            "city": "SHELBURN",
            "state": "IN",
            "postal_code": "478791202",
            "telephone_number": "812-562-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "SHANNA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-26",
        "last_updated": "2021-03-23",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006501A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "2019035100",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71006501A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNA",
            "last_name": "SOUTHWOOD",
            "middle_name": "LYNN",
            "credential": "PMHNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Internal Medicine Nephrology, Inc.
• Divyesh Purohit, MD
• Sullivan County Internal Medicine LLC
• Terre Haute Pulmonary & Pediatric Clinic, LLC (Shelburn Medical Clinic)
• Union Associated Physicians Clinic, LLC
• Emily Whitman, CCC-SLP

• Psychiatric/Mental Health Nurse Practitioner in Shelburn, IN
• Providers in Shelburn, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.